Provider Demographics
NPI:1578535910
Name:QUAN, MATTHEW BRETT (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRETT
Last Name:QUAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WEST 15 ST 21A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:917-721-4901
Mailing Address - Fax:212-366-9419
Practice Address - Street 1:700 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-517-6555
Practice Address - Fax:212-472-6796
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216306207N00000X, 207ND0101X
CAG073273207N00000X
NJMA70706207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2299453OtherGHI
216306OtherAETNA PPO HMO
3C3691OtherHEALTHNET
3K1153OtherBCBS
P2527966OtherOXFORD
2K4851Medicare ID - Type Unspecified
P2527966OtherOXFORD