Provider Demographics
NPI:1629498837
Name:KATCHER, MATTHEW L (LMT, LAC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:L
Last Name:KATCHER
Suffix:
Gender:M
Credentials:LMT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MONROE BLVD
Mailing Address - Street 2:APT 3B
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4344
Mailing Address - Country:US
Mailing Address - Phone:516-850-4894
Mailing Address - Fax:
Practice Address - Street 1:55 MONROE BLVD
Practice Address - Street 2:APT 3B
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4344
Practice Address - Country:US
Practice Address - Phone:516-850-4894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-27
Last Update Date:2014-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004929171100000X
NY014016225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist