Healthcare Provider Details

I. General information

NPI: 1225992100
Provider Name (Legal Business Name): MATTHEW KROON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 SOUTH AVE BLDG SUITE SUITE 704
STATEN ISLAND NY
10314-3779
US

IV. Provider business mailing address

8 COLLEGE AVE
STATEN ISLAND NY
10314-2418
US

V. Phone/Fax

Practice location:
  • Phone: 718-303-9777
  • Fax: 718-303-9778
Mailing address:
  • Phone: 718-303-9777
  • Fax: 718-303-9778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number055499
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: