Provider Demographics
NPI:1942400783
Name:LABELLA, MATTHEW G (PA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:G
Last Name:LABELLA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2209 GENESEE ST
Mailing Address - Street 2:BUSINESS OFFICE ROOM 315
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5930
Mailing Address - Country:US
Mailing Address - Phone:315-801-3282
Mailing Address - Fax:315-801-8391
Practice Address - Street 1:89 GENESEE ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2336
Practice Address - Country:US
Practice Address - Phone:315-735-2294
Practice Address - Fax:315-735-2021
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY011928363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03126161Medicaid
NYJ400019470Medicare PIN