Provider Demographics
NPI:1619134269
Name:WOSNITZER, MATTHEW S (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:S
Last Name:WOSNITZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:425 POST RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6232
Mailing Address - Country:US
Mailing Address - Phone:212-305-0112
Mailing Address - Fax:212-305-0114
Practice Address - Street 1:425 POST RD
Practice Address - Street 2:SUITE 204
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6232
Practice Address - Country:US
Practice Address - Phone:212-305-0112
Practice Address - Fax:212-305-0114
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY246417208800000X
CT053175208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1619134269Medicaid
CT1619134269Medicaid