Provider Demographics
NPI:1528401007
Name:THOMASHEFSKI, MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:THOMASHEFSKI
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 1:127 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LEROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-1317
Mailing Address - Country:US
Mailing Address - Phone:585-768-2620
Mailing Address - Fax:585-768-2694
Practice Address - Street 1:127 WEST MAIN STREET
Practice Address - Street 2:LEROY MEDICAL ASSOCIATES
Practice Address - City:LEROY
Practice Address - State:NY
Practice Address - Zip Code:14482-1317
Practice Address - Country:US
Practice Address - Phone:585-768-2620
Practice Address - Fax:585-768-2694
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283849363AM0700X
NY28384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical