Provider Demographics
NPI:1487427480
Name:MATUSZEWICZ, ARIELLE REGINA TOVA
Entity type:Individual
Prefix:
First Name:ARIELLE
Middle Name:REGINA TOVA
Last Name:MATUSZEWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 FANNING ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5309
Mailing Address - Country:US
Mailing Address - Phone:718-664-3402
Mailing Address - Fax:
Practice Address - Street 1:259 FANNING ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5309
Practice Address - Country:US
Practice Address - Phone:718-664-3402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist