Provider Demographics
NPI:1447854328
Name:KRIEGER, MATTHEW JOHN (NP)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JOHN
Last Name:KRIEGER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 MARCUS AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2024
Mailing Address - Country:US
Mailing Address - Phone:347-378-9898
Mailing Address - Fax:
Practice Address - Street 1:1985 MARCUS AVE # 100
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2008
Practice Address - Country:US
Practice Address - Phone:855-201-4988
Practice Address - Fax:844-832-6320
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF346770-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily