Provider Demographics
NPI:1457589541
Name:WROBEL, MATTHEW J (LMT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:WROBEL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8943 GASKIN RD
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-1412
Mailing Address - Country:US
Mailing Address - Phone:716-462-8529
Mailing Address - Fax:
Practice Address - Street 1:8943 GASKIN RD
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1412
Practice Address - Country:US
Practice Address - Phone:716-462-8529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20916174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist