Provider Demographics
NPI:1083676704
Name:BROWN, MATTHEW T (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:T
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8390 OSWEGO ROAD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NJ
Mailing Address - Zip Code:13090-1002
Mailing Address - Country:US
Mailing Address - Phone:315-652-4323
Mailing Address - Fax:315-622-1110
Practice Address - Street 1:8390 OSWEGO ROAD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NJ
Practice Address - Zip Code:13090-1002
Practice Address - Country:US
Practice Address - Phone:315-652-4323
Practice Address - Fax:315-622-1110
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0213631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02450062Medicaid
NYCC3612Medicare ID - Type Unspecified