Provider Demographics
NPI:1578650859
Name:SPIEGELMAN, MATTHEW G (MPT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:G
Last Name:SPIEGELMAN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8235 134TH ST
Mailing Address - Street 2:APT. 3A
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1400
Mailing Address - Country:US
Mailing Address - Phone:347-564-4303
Mailing Address - Fax:
Practice Address - Street 1:190 UNION AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7411
Practice Address - Country:US
Practice Address - Phone:718-387-7420
Practice Address - Fax:718-387-7421
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022095-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ01E11Medicare PIN