Provider Demographics
NPI:1972105435
Name:LANGAMAN, MATTHEW GRANT (DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GRANT
Last Name:LANGAMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4304
Mailing Address - Country:US
Mailing Address - Phone:917-648-7749
Mailing Address - Fax:
Practice Address - Street 1:8718 BAY PKWY STE 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5273
Practice Address - Country:US
Practice Address - Phone:917-310-5754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046517208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation