Basic Information
| Provider Information | |||||||||
| NPI: | 1821309816 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIERRE | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | N. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | SLP, RRT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 LINDEN BLVD | ||||||||
| Address2: | APT 34C | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112263311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189421434 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1651 CONEY ISLAND AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112305849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189981415 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2010 | ||||||||
| LastUpdateDate: | 06/24/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 227900000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.