Provider Demographics
NPI:1700595501
Name:KING, MATTHEW ALDRIDGE (CRT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ALDRIDGE
Last Name:KING
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 STATE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-8303
Mailing Address - Country:US
Mailing Address - Phone:804-307-7569
Mailing Address - Fax:
Practice Address - Street 1:903 STATE ST APT 1
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-8303
Practice Address - Country:US
Practice Address - Phone:804-307-7569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004970227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified