Provider Demographics
NPI:1174653869
Name:VOGEL, MATTHEW ROSS (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ROSS
Last Name:VOGEL
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:PO BOX 1229
Mailing Address - Street 2:
Mailing Address - City:BRIDGEHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11932-1229
Mailing Address - Country:US
Mailing Address - Phone:631-537-7850
Mailing Address - Fax:631-537-9707
Practice Address - Street 1:128 SAG HARBOR TURNPIKE
Practice Address - Street 2:
Practice Address - City:BRIDGEHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11932
Practice Address - Country:US
Practice Address - Phone:631-537-7850
Practice Address - Fax:631-537-9707
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017738225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP03292Medicare UPIN
NYQA5431Medicare ID - Type Unspecified