1003286949 NPI number — DR. MATTHEW CHARLES CONROY D.C

Table of content: DR. MATTHEW CHARLES CONROY D.C (NPI 1003286949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003286949 NPI number — DR. MATTHEW CHARLES CONROY D.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONROY
Provider First Name:
MATTHEW
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C
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:
1003286949
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
556 HORSESHOE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18040-6526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-515-5741
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1281 PA-113
Provider Second Line Business Practice Location Address:
UNIT B
Provider Business Practice Location Address City Name:
BLOOMING GLEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-257-3938
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2015

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: 111NX0800X , with the licence number:  DC011069 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com