Healthcare Provider Details

I. General information

NPI: 1528845161
Provider Name (Legal Business Name): MANIN MATHEW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 03/09/2025
Certification Date: 03/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CROSFIELD AVE
WEST NYACK NY
10994-2226
US

IV. Provider business mailing address

8 SPRING RD
VALLEY COTTAGE NY
10989-2112
US

V. Phone/Fax

Practice location:
  • Phone: 845-358-8989
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number051942-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: