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General NPI Number Information
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NPI Number | 1629554738
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Entity Type | Individual
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Provider Name | MATTHEW JOSEPH BANKOWSKI MS, PHD, D(ABMM)
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Gender | Male
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 12/23/2023
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Provider Practice Location Address
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Address Line | 7608 HAMPTON HILLS LOOP
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City | NEW PORT RICHEY
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State | FL
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Zip | 34654-6207
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Country | US
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Telephone | 612-801-2597
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Fax |
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Provider Business Mailing Address
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Address Line | 7608 HAMPTON HILLS LOOP
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City | NEW PORT RICHEY
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State | FL
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Zip | 34654-6207
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Country | US
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Telephone | 612-801-2597
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Fax |
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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 | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number | DI30550
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207ZM0300X
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Taxonomy Name | Medical Microbiology Physician
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License Number | DI30550
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License Number State | FL
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