Provider Demographics
NPI:1053328468
Name:GOODEMOTE, MATTHEW T (MPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:T
Last Name:GOODEMOTE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MAPLE DELL
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2951
Mailing Address - Country:US
Mailing Address - Phone:518-306-6894
Mailing Address - Fax:518-450-1580
Practice Address - Street 1:3 MAPLE DELL
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2951
Practice Address - Country:US
Practice Address - Phone:518-306-6894
Practice Address - Fax:518-450-1580
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0171611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10076606OtherCDPHP GROUP# K0
NY710206OtherMVP
NY6400651OtherUNITED HEALTCARE
NYBSNENY 000922986005OtherBSNENY EAST STATE ST
BSNENY 000922986006OtherBSNENY COMRIE AVE
NYEMPIRE ST Q09S11OtherEMPIRE BCBS
NY02441963Medicaid
NY02441963Medicaid
BSNENY 000922986006OtherBSNENY COMRIE AVE