Healthcare Provider Details

I. General information

NPI: 1588508444
Provider Name (Legal Business Name): MATTHEW VAHLING PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 MORRIS PARK AVE
BRONX NY
10461-1949
US

IV. Provider business mailing address

225 E 39TH ST APT 9E
NEW YORK NY
10016-2279
US

V. Phone/Fax

Practice location:
  • Phone: 646-592-4734
  • Fax:
Mailing address:
  • Phone: 631-609-0638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number035522-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: