Provider Demographics
NPI:1225187743
Name:DENNO, MATTHEW L (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:L
Last Name:DENNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 NORTH FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561
Mailing Address - Country:US
Mailing Address - Phone:845-255-7900
Mailing Address - Fax:845-255-7901
Practice Address - Street 1:26 NORTH FRONT STREET
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561
Practice Address - Country:US
Practice Address - Phone:845-255-7900
Practice Address - Fax:845-255-7901
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02042822Medicaid
NY9X708NW001Medicare PIN
NYG64158Medicare UPIN
NYRB5790Medicare PIN