Healthcare Provider Details

I. General information

NPI: 1336094804
Provider Name (Legal Business Name): JAMES MATTHEW PREUT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1268 FOREST AVE
STATEN ISLAND NY
10302-2312
US

IV. Provider business mailing address

1268 FOREST AVE
STATEN ISLAND NY
10302-2312
US

V. Phone/Fax

Practice location:
  • Phone: 718-981-8117
  • Fax: 718-632-1568
Mailing address:
  • Phone: 347-251-9983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number40680
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: