Healthcare Provider Details

I. General information

NPI: 1710719786
Provider Name (Legal Business Name): SETH MATTHEW MEAD RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2024
Last Update Date: 08/17/2024
Certification Date: 08/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BALD HILL RD
BROOKTONDALE NY
14817-9716
US

IV. Provider business mailing address

300 BALD HILL RD
BROOKTONDALE NY
14817-9716
US

V. Phone/Fax

Practice location:
  • Phone: 607-351-1661
  • Fax:
Mailing address:
  • Phone: 607-351-1661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number657550-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: