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NPI Code Detail

MEDICARE: AMANDA MARIE MATRA

MEDICARE: AMANDA MARIE MATRA
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
1207R00000XInternal Medicine Physician325278-01NY

General Provider Information

NPI Number : 1275152191
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA MARIE MATRA
Provider Business Mailing Address
First Line : 475 SEAVIEW AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-3436
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 475 SEAVIEW AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-3436
Country : US
Telephone Number : 914-557-4209
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2020
Last Update Date : 03/16/2026

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Directions to “ AMANDA MARIE MATRA ” Practice Location

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