Provider Demographics
NPI:1548800972
Name:NESHEIWAT, MATTHEW REYAD (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:REYAD
Last Name:NESHEIWAT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 BEYER DR
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-5604
Mailing Address - Country:US
Mailing Address - Phone:845-392-6763
Mailing Address - Fax:
Practice Address - Street 1:52 ROUTE 17K STE 203
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3920
Practice Address - Country:US
Practice Address - Phone:845-392-6763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor