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General NPI Number Information
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NPI Number | 1962221655
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Entity Type | Individual
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Provider Name | BILLIE MATTIOLI
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Gender | Female
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 5501 OLD YORK RD
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City | PHILADELPHIA
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State | PA
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Zip | 19141-3018
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Country | US
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Telephone | 215-456-7890
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Fax |
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Provider Business Mailing Address
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Address Line | 2 N PLAZA PL
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City | ATLANTIC CITY
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State | NJ
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Zip | 08401-3332
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Country | US
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Telephone | 856-305-5941
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA066133
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License Number State | PA
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