Basic Information
Provider Information
NPI: 1922235449
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WESTPFAL
FirstName: MATTHEW
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5008 BRITTONFIELD PKWY
Address2: SUITE 100
City: EAST SYRACUSE
State: NY
PostalCode: 130579248
CountryCode: US
TelephoneNumber: 3152347609
FaxNumber: 3152348890
Practice Location
Address1: 5008 BRITTONFIELD PKWY
Address2: SUITE 100
City: EAST SYRACUSE
State: NY
PostalCode: 130579248
CountryCode: US
TelephoneNumber: 3152347609
FaxNumber: 3152348890
Other Information
ProviderEnumerationDate: 06/11/2009
LastUpdateDate: 10/30/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X278422NYY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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