Individual
MATTHEW JAMES PROCACCINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
475 SEAVIEW AVE, STATEN ISLAND, NY 10305
(718) 226-9158
(718) 226-6964
Mailing address
ONE EDGEWATER STREET, STATEN ISLAND, NY 10305
(718) 226-1013
(718) 226-1039
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
013719
NY
363AM0700X
Medical Physician Assistant
Primary
6015
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03183557
—
NY
Enumeration date
08/20/2008
Last updated
03/23/2023
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