Healthcare Provider Details

I. General information

NPI: 1164036612
Provider Name (Legal Business Name): MATTHEW BUCHNER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 GARDINERS AVE
LEVITTOWN NY
11756-3707
US

IV. Provider business mailing address

170 GARDINERS AVE
LEVITTOWN NY
11756-3707
US

V. Phone/Fax

Practice location:
  • Phone: 516-288-7744
  • Fax: 516-495-4828
Mailing address:
  • Phone: 516-288-7744
  • Fax: 516-495-4828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number046019
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: