Healthcare Provider Details

I. General information

NPI: 1689560203
Provider Name (Legal Business Name): MR. MATTHEW PAUL PIZZARIELLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH ST
BROOKLYN NY
11215-3609
US

IV. Provider business mailing address

48 RUSSEK DR
STATEN ISLAND NY
10312-1630
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-3000
  • Fax:
Mailing address:
  • Phone: 718-962-4228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number721744-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: