Provider Demographics
NPI:1215309562
Name:MASCIANDARO, MATTHEW (DPT FMT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:MASCIANDARO
Suffix:
Gender:M
Credentials:DPT FMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 LARKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-2415
Mailing Address - Country:US
Mailing Address - Phone:631-261-1370
Mailing Address - Fax:
Practice Address - Street 1:279 LARKFIELD RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-2415
Practice Address - Country:US
Practice Address - Phone:631-261-1370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038144-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist