Provider Demographics
NPI:1821807447
Name:LYDON, MATTHEW JAMES (RN)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAMES
Last Name:LYDON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PINEHURST AVE
Mailing Address - Street 2:
Mailing Address - City:COLONIE
Mailing Address - State:NY
Mailing Address - Zip Code:12205-3545
Mailing Address - Country:US
Mailing Address - Phone:518-929-5383
Mailing Address - Fax:
Practice Address - Street 1:12 PINEHURST AVE
Practice Address - Street 2:
Practice Address - City:COLONIE
Practice Address - State:NY
Practice Address - Zip Code:12205-3545
Practice Address - Country:US
Practice Address - Phone:518-929-5383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY817147163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse