1033170345 NPI number — MR. MATTHEW T LUMLEY PT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033170345 NPI number — MR. MATTHEW T LUMLEY PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUMLEY
Provider First Name:
MATTHEW
Provider Middle Name:
T
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033170345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 HALFMOON EXECUTIVE PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLIFTON PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-371-6777
Provider Business Mailing Address Fax Number:
518-383-9033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HALFMOON EXECUTIVE PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLIFTON PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-371-6777
Provider Business Practice Location Address Fax Number:
518-383-9033
Provider Enumeration Date:
03/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  013329 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01403516 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com