Matt Smith, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

003747 Issued in NY

Practice address

3261 W State Rd
Saint Bonaventure, NY 14778

Phone

(716) 375-2230

NPI assigned

Apr 1, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543968000000",
    "number": "1124481601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1604 WILHOIT AVE",
            "city": "LEWIS CENTER",
            "state": "OH",
            "postal_code": "430357933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3261 W STATE RD",
            "city": "SAINT BONAVENTURE",
            "state": "NY",
            "postal_code": "14778",
            "telephone_number": "716-375-2230"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1604 Wilhoit Ave",
            "address_purpose": "LOCATION",
            "city": "Lewis Center",
            "state": "OH",
            "postal_code": "430357933",
            "country_code": "US",
            "telephone_number": "740-816-3770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MATT",
        "credential": "LAT, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-01",
        "last_updated": "2018-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NY",
            "license": "003747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Lombardo
• Diana V. Nguyen, PA-C
• Jennifer Nguyen
• Francesca Parry, NP
• Jesus R Perez Jr., PA-C
• St. Bonaventure University
• Carley Fern Stevenson
• Gianna Marie Trillo
• Nicole Elise Tschiderer
• Diane Vu

• Athletic Trainer in Saint Bonaventure, NY
• Providers in Saint Bonaventure, NY by specialty
• Athletic Trainer in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.