Healthcare Provider Details

I. General information

NPI: 1053256164
Provider Name (Legal Business Name): MATTHEW LEMA ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2-22 BANTA PL
FAIR LAWN NJ
07410-3058
US

IV. Provider business mailing address

787 RAVENHILL PL
RIDGEFIELD NJ
07657-1309
US

V. Phone/Fax

Practice location:
  • Phone: 866-936-9556
  • Fax:
Mailing address:
  • Phone: 201-587-3808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000058909
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: