Active NPI
Matthew William Freudenberg
- Licensed Practical Nurse
- Riverhead, NY
National Provider Identifier
1578815494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 10 253806
- Practice address
- 22 Further LN
Riverhead, NY 11901-2314 - Phone
- (631) 727-9180
- NPI assigned
- Oct 3, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 10 253806 | NY | Primary |
Addresses
Primary practice location
22 Further LN
Riverhead, NY 11901-2314
Mailing address
22 Further LN
Riverhead, NY 11901-2314
Phone (631) 727-9180
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10 253806 | NY | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349222400000",
"number": "1578815494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 FURTHER LN",
"city": "RIVERHEAD",
"state": "NY",
"postal_code": "119012314",
"telephone_number": "631-727-9180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 FURTHER LN",
"city": "RIVERHEAD",
"state": "NY",
"postal_code": "119012314",
"telephone_number": "631-727-9180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREUDENBERG",
"first_name": "MATTHEW",
"middle_name": "WILLIAM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-10-03",
"last_updated": "2012-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "10 253806",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverhead, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.