=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053256164
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW LEMA ATC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2026
-----------------------------------------------------
Last Update Date | 04/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2-22 BANTA PL
-----------------------------------------------------
City | FAIR LAWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07410-3058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-936-9556
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 787 RAVENHILL PL
-----------------------------------------------------
City | RIDGEFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07657-1309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-587-3808
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 2000058909
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------