Healthcare Provider Details

I. General information

NPI: 1275065708
Provider Name (Legal Business Name): MATTHEW SPORN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 5TH AVE # 1B
NEW YORK NY
10128-0104
US

IV. Provider business mailing address

118 WINDING BROOK RD
NEW ROCHELLE NY
10804-2010
US

V. Phone/Fax

Practice location:
  • Phone: 212-988-8269
  • Fax:
Mailing address:
  • Phone: 914-582-9938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number338237
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: