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NPI Code Detail

MEDICARE: DR. ANGELO SALVATORE MATERIA MD

MEDICARE: DR. ANGELO SALVATORE MATERIA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramNY
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1184329799
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANGELO SALVATORE MATERIA MD
Provider Business Mailing Address
First Line : 2201 HEMPSTEAD TPKE
Second Line :
City : EAST MEADOW
State : NY
Zip : 11554-1859
Country : US
Telephone Number : 516-572-0123
Fax Number :
Provider Business Practice Location Address
First Line : 301 E MAIN ST
Second Line :
City : BAY SHORE
State : NY
Zip : 11706-8408
Country : US
Telephone Number : 631-968-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2023
Last Update Date : 06/10/2026

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