Provider Demographics
NPI:1508835760
Name:O'NEIL, MATTHEW GERARD (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GERARD
Last Name:O'NEIL
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 1:2388 ROUTE 9
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MECHANICVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12118-3024
Mailing Address - Country:US
Mailing Address - Phone:518-899-1140
Mailing Address - Fax:518-899-1139
Practice Address - Street 1:2388 ROUTE 9
Practice Address - Street 2:SUITE 102
Practice Address - City:MECHANICVILLE
Practice Address - State:NY
Practice Address - Zip Code:12118-3024
Practice Address - Country:US
Practice Address - Phone:518-899-1140
Practice Address - Fax:518-899-1139
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10006257OtherCDPHP
NY01699912Medicaid
NY43126OtherMVP HEALTHCARE
NY00492393002OtherBLUE SHIELD
NYMOOQ715410OtherEMPIRE BC/BS
NY10006257OtherCDPHP