Healthcare Provider Details

I. General information

NPI: 1023924586
Provider Name (Legal Business Name): MATTHEW JOSEPH LIPERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 NASSAU BLVD
GARDEN CITY SOUTH NY
11530-5313
US

IV. Provider business mailing address

14 SALEM WAY
GLEN HEAD NY
11545-1137
US

V. Phone/Fax

Practice location:
  • Phone: 516-292-5141
  • Fax:
Mailing address:
  • Phone: 516-697-6343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number074280
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: