1013002104 NPI number — MR. MATTHEW L. SHEBES RPA-C, MHA

Table of content: MR. MATTHEW L. SHEBES RPA-C, MHA (NPI 1013002104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013002104 NPI number — MR. MATTHEW L. SHEBES RPA-C, MHA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEBES
Provider First Name:
MATTHEW
Provider Middle Name:
L.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPA-C, MHA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013002104
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 TULIPWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COMMACK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11725-5616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-543-6112
Provider Business Mailing Address Fax Number:
718-343-3429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LONG ISLAND JEWISH MEDICAL CENTER-DEPARTMENT OF SURGERY
Provider Second Line Business Practice Location Address:
270-05, 76 AVE
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-470-7210
Provider Business Practice Location Address Fax Number:
718-343-3429
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  002441 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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