Healthcare Provider Details

I. General information

NPI: 1538074703
Provider Name (Legal Business Name): MATTHEW MARK FERRARO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CENTER ST STE 4
FREDONIA NY
14063-1769
US

IV. Provider business mailing address

12 CENTER ST STE 4
FREDONIA NY
14063-1769
US

V. Phone/Fax

Practice location:
  • Phone: 716-934-3641
  • Fax: 716-679-9698
Mailing address:
  • Phone: 716-934-3641
  • Fax: 716-679-9698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF360320-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: