MEDICARE: MATTHEW T GOODEMOTE MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	0171611	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10076606	OTHER	NY	CDPHP GROUP# K0
2	710206	OTHER	NY	MVP
3	6400651	OTHER	NY	UNITED HEALTCARE
4	BSNENY 000922986005	OTHER	NY	BSNENY EAST STATE ST
5	BSNENY 000922986006	OTHER		BSNENY COMRIE AVE
6	EMPIRE ST Q09S11	OTHER	NY	EMPIRE BCBS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053328468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW T GOODEMOTE MPT

Provider Business Mailing Address
First Line	:	3 MAPLE DELL
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-2951
Country	:	US
Telephone Number	:	518-306-6894
Fax Number	:	518-450-1580

Provider Business Practice Location Address
First Line	:	3 MAPLE DELL
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-2951
Country	:	US
Telephone Number	:	518-306-6894
Fax Number	:	518-450-1580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/15/2015

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