Provider Demographics
NPI:1669723847
Name:MATTERA, CATHERINE
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:
Last Name:MATTERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 NORMAN DR
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-1321
Mailing Address - Country:US
Mailing Address - Phone:631-567-4713
Mailing Address - Fax:
Practice Address - Street 1:31 NORMAN DR
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-1321
Practice Address - Country:US
Practice Address - Phone:631-567-4713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY368950-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse