Healthcare Provider Details

I. General information

NPI: 1932099645
Provider Name (Legal Business Name): MATTHEW LUTHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2025
Last Update Date: 07/04/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 WENDE HALL
BUFFALO NY
14214-8013
US

IV. Provider business mailing address

2389 WALWORTH RD
WALWORTH NY
14568-9509
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-3740
  • Fax:
Mailing address:
  • Phone: 607-483-8731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number809016
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: