Healthcare Provider Details

I. General information

NPI: 1780412023
Provider Name (Legal Business Name): MATTHEW REID BECAN COF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 S 9TH ST STE 102
STROUDSBURG PA
18360-1630
US

IV. Provider business mailing address

18 S 9TH ST STE 102
STROUDSBURG PA
18360-1630
US

V. Phone/Fax

Practice location:
  • Phone: 610-844-7586
  • Fax: 215-723-5176
Mailing address:
  • Phone: 610-844-7586
  • Fax: 215-723-5176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberOF000058
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: