Provider Demographics
NPI:1144399171
Name:MAURER, MATTHEW ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ANTHONY
Last Name:MAURER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 SAINT NICHOLAS AVE
Mailing Address - Street 2:ROOM 217C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3802
Mailing Address - Country:US
Mailing Address - Phone:212-851-4761
Mailing Address - Fax:212-851-4572
Practice Address - Street 1:1130 SAINT NICHOLAS AVE
Practice Address - Street 2:ROOM 217C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3802
Practice Address - Country:US
Practice Address - Phone:212-851-4761
Practice Address - Fax:212-851-4572
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2008-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225147207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC04478Medicare UPIN