Provider Demographics
NPI:1871678706
Name:HINGE, MATTHEW JUDE (RPA-C MSPA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JUDE
Last Name:HINGE
Suffix:
Gender:M
Credentials:RPA-C MSPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1205
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:NY
Mailing Address - Zip Code:12946-5205
Mailing Address - Country:US
Mailing Address - Phone:518-523-5629
Mailing Address - Fax:
Practice Address - Street 1:75 PARK ST.
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NY
Practice Address - Zip Code:12932-0277
Practice Address - Country:US
Practice Address - Phone:518-873-6377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008858363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00268033OtherRAIL ROAD MEDICARE
NYP69771Medicare UPIN