Provider Demographics
NPI:1871374736
Name:MATTERA, SYDNEY KRISTINE (PA-C)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:KRISTINE
Last Name:MATTERA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1712
Mailing Address - Country:US
Mailing Address - Phone:201-638-1237
Mailing Address - Fax:
Practice Address - Street 1:63 GRAND AVE
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-1930
Practice Address - Country:US
Practice Address - Phone:201-696-2646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00814100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant