Provider Demographics
NPI:1437108263
Name:ISELIN, MATTHEW (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ISELIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 20TH ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-1180
Mailing Address - Country:US
Mailing Address - Phone:347-529-6465
Mailing Address - Fax:347-763-0054
Practice Address - Street 1:164 20TH ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-1180
Practice Address - Country:US
Practice Address - Phone:347-529-6465
Practice Address - Fax:347-763-0054
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY018589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400026576Medicare PIN