Provider Demographics
NPI:1972670610
Name:ROBINSON, MATTHEW J (LIC AC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6369
Mailing Address - Country:US
Mailing Address - Phone:781-899-2121
Mailing Address - Fax:
Practice Address - Street 1:25 GRANT ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-4201
Practice Address - Country:US
Practice Address - Phone:781-899-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202432171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist