Provider Demographics
NPI:1376136549
Name:MEYER, MATTHEW JON (DMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JON
Last Name:MEYER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 W 45TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4921
Mailing Address - Country:US
Mailing Address - Phone:212-382-3782
Mailing Address - Fax:
Practice Address - Street 1:205 E MAIN ST STE 1-1
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-7934
Practice Address - Country:US
Practice Address - Phone:631-421-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062747122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist