Healthcare Provider Details

I. General information

NPI: 1508835760
Provider Name (Legal Business Name): MATTHEW GERARD O'NEIL P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2388 ROUTE 9 SUITE 102
MECHANICVILLE NY
12118-3024
US

IV. Provider business mailing address

2388 ROUTE 9 SUITE 102
MECHANICVILLE NY
12118-3024
US

V. Phone/Fax

Practice location:
  • Phone: 518-899-1140
  • Fax: 518-899-1139
Mailing address:
  • Phone: 518-899-1140
  • Fax: 518-899-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number011078
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: