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General NPI Number Information
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NPI Number | 1124032727
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Entity Type | Individual
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Provider Name | MATTHEW ALBERT PT, MSPT
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Gender | Male
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 07/13/2011
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Provider Practice Location Address
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Address Line | 44 STATE RT 23 SUITE 15B
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City | RIVERDALE
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State | NJ
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Zip | 07457-1603
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Country | US
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Telephone | 973-400-1716
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Fax | 973-513-9882
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Provider Business Mailing Address
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Address Line | 44 STATE RT 23 SUITE 15B
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City | RIVERDALE
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State | NJ
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Zip | 07457-1603
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Country | US
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Telephone | 973-400-1716
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Fax | 973-513-9882
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA00943700
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License Number State | NJ
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