MEDICARE: MRS. LORI S. MATULEWICZ N.P.P.

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F401682-1	NY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F-401682	NY

General Provider Information

NPI Number	:	1679993828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI S. MATULEWICZ N.P.P.

Provider Business Mailing Address
First Line	:	500 CENTRAL AVE
Second Line	:	EQUINOX, INC.
City	:	ALBANY
State	:	NY
Zip	:	12206
Country	:	US
Telephone Number	:	518-435-9931
Fax Number	:	518-435-9937

Provider Business Practice Location Address
First Line	:	500 CENTRAL AVE.
Second Line	:	EQUINOX, INC.
City	:	ALBANY
State	:	NY
Zip	:	12206
Country	:	US
Telephone Number	:	518-435-9931
Fax Number	:	518-435-9937

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

Provider Enumeration Date	:	04/25/2014
Last Update Date	:	06/07/2026

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