MEDICARE: PETER GEORGE MATTER

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
1	183500000X	Pharmacist	073644	NY

General Provider Information

NPI Number	:	1467319442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER GEORGE MATTER

Provider Business Mailing Address
First Line	:	12 NEW DORP LN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2323
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 NEW DORP LN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2323
Country	:	US
Telephone Number	:	917-456-1066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/29/2026

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