Healthcare Provider Details

I. General information

NPI: 1841645223
Provider Name (Legal Business Name): MATTHEW JAMES CAMPBELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 BAINBRIDGE AVE
BRONX NY
10467-2801
US

IV. Provider business mailing address

2108 N ST # 10209
SACRAMENTO CA
95816-5712
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-7967
  • Fax: 534-429-4308
Mailing address:
  • Phone: 909-378-5135
  • Fax: 534-429-4308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number295971
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number75354
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: