Healthcare Provider Details

I. General information

NPI: 1124934112
Provider Name (Legal Business Name): MATTHEW IMBROGNO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 VETERANS BLVD STE 2
MASSAPEQUA NY
11758-4913
US

IV. Provider business mailing address

1048 WHITE BIRCH LN
WANTAGH NY
11793-1609
US

V. Phone/Fax

Practice location:
  • Phone: 516-581-2461
  • Fax:
Mailing address:
  • Phone: 516-581-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number117620
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: