Provider Demographics
NPI:1265846653
Name:LANSING PAIN AND REHAB PLLC
Entity Type:Organization
Organization Name:LANSING PAIN AND REHAB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MATFUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-294-1010
Mailing Address - Street 1:1717 E MICHIGAN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-2840
Mailing Address - Country:US
Mailing Address - Phone:517-253-8360
Mailing Address - Fax:
Practice Address - Street 1:1717 E MICHIGAN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-2840
Practice Address - Country:US
Practice Address - Phone:517-253-8360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009983111N00000X
MI4301105023207R00000X
MI5501009083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00409105Medicaid
FLCY522AMedicare PIN
NYB12770Medicare UPIN