Provider Demographics
NPI:1245229376
Name:MOBIUS, MATTHEW PAUL I (MS,PT,OCS)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:PAUL
Last Name:MOBIUS
Suffix:I
Gender:M
Credentials:MS,PT,OCS
Other - Prefix:
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Mailing Address - Street 1:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11969
Mailing Address - Country:US
Mailing Address - Phone:631-377-3488
Mailing Address - Fax:631-377-3490
Practice Address - Street 1:1370-A MAJORS PATH
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968
Practice Address - Country:US
Practice Address - Phone:631-377-3488
Practice Address - Fax:631-377-3490
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0163951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ22531Medicare PIN