1346608403 NPI number — MR. MATTHEW MURPHY CASTINE LICENSED CLINICAL SO

Table of content: MR. MATTHEW MURPHY CASTINE LICENSED CLINICAL SO (NPI 1346608403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346608403 NPI number — MR. MATTHEW MURPHY CASTINE LICENSED CLINICAL SO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTINE
Provider First Name:
MATTHEW
Provider Middle Name:
MURPHY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LICENSED CLINICAL SO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COOPER
Provider Other First Name:
MATTHEW
Provider Other Middle Name:
MURPHY
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICENSED MASTER SOCI
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346608403
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 SIXTH AVENUE (SAMARITAN HOSPITAL PROS)
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-271-1122
Provider Business Mailing Address Fax Number:
518-271-1791

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 SIXTH AVENUE (SAMARITAN HOSPITAL PROS)
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-271-1122
Provider Business Practice Location Address Fax Number:
518-271-1791
Provider Enumeration Date:
02/04/2016

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: 1041C0700X , with the licence number:  088207 , 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)