Provider Demographics
NPI:1114158383
Name:CANTOR, MATTHEW DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVID
Last Name:CANTOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:19 BRADHURST AVE
Mailing Address - Street 2:SUITE 3100N
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-909-9018
Mailing Address - Fax:914-909-9028
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:SUITE 2700
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-493-2250
Practice Address - Fax:914-493-2060
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2016-01-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY271616207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY271616OtherNYS LICENSE
NY03653032Medicaid
NY271616OtherNYS LICENSE