Healthcare Provider Details

I. General information

NPI: 1205763224
Provider Name (Legal Business Name): MATTHEW CHRISIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 W 35TH ST RM 403
NEW YORK NY
10001-0215
US

IV. Provider business mailing address

213 W 35TH ST RM 403
NEW YORK NY
10001-0215
US

V. Phone/Fax

Practice location:
  • Phone: 212-576-4104
  • Fax:
Mailing address:
  • Phone: 212-576-4104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: