Matthew James Lydon, RN
Individual provider Active NPI Registered Nurse · Colonie, NY
NPI 1821807447 · NPPES record last updated Jan 7, 2025
Key facts
- NPI
- 1821807447
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 817147 (NY)
- Practice address
- 12 Pinehurst Ave
Colonie, NY 12205-3545 - Phone
- (518) 929-5383
- NPI assigned
- Jan 7, 2025
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 817147 | NY | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 817147 | NY | Yes |
Addresses
Primary practice location
12 Pinehurst Ave
Colonie, NY 12205-3545
Mailing address
12 Pinehurst Ave
Colonie, NY 12205-3545
Phone (518) 929-5383
Other providers in Colonie, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.