Healthcare Provider Details

I. General information

NPI: 1275100729
Provider Name (Legal Business Name): MATTHEW NOURMAND DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E 40TH ST RM 506
NEW YORK NY
10016-1235
US

IV. Provider business mailing address

169 FROEHLICH FARM BLVD
WOODBURY NY
11797-2906
US

V. Phone/Fax

Practice location:
  • Phone: 212-685-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number062969-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: