Healthcare Provider Details

I. General information

NPI: 1780975706
Provider Name (Legal Business Name): MATTHEW WILLIAM COWAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3332 ROCHAMBEAU AVE STE C
BRONX NY
10467-2836
US

IV. Provider business mailing address

3332 ROCHAMBEAU AVE STE C
BRONX NY
10467-2836
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-6311
  • Fax: 718-920-6313
Mailing address:
  • Phone: 718-920-6311
  • Fax: 718-920-6313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number310909
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: