Provider Demographics
NPI:1619040425
Name:PULLANO, MATTHEW DAVID (PT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DAVID
Last Name:PULLANO
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 1:3125 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5958
Mailing Address - Country:US
Mailing Address - Phone:607-748-7369
Mailing Address - Fax:607-748-4189
Practice Address - Street 1:3125 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-5958
Practice Address - Country:US
Practice Address - Phone:607-748-7369
Practice Address - Fax:607-748-4189
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017307-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10035643-J508OtherCDPHP
NY200486570OtherCOMP, RMSCO, CIGNA
NY5392510OtherAETNA
NY000021582OtherBCBS
NY438500OtherMVP
NY816782OtherGHI & MPN