Healthcare Provider Details

I. General information

NPI: 1417219304
Provider Name (Legal Business Name): MATTHEW FREDERICK VONUNWERTH PH.D., L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MATTHEW FREDERICK VON UNWERTH PH.D., L.P.

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W 56TH ST APT 1F
NEW YORK NY
10019-3734
US

IV. Provider business mailing address

529 E 85TH ST APARTMENT 3A
NEW YORK NY
10028-7441
US

V. Phone/Fax

Practice location:
  • Phone: 917-535-4797
  • Fax:
Mailing address:
  • Phone: 917-535-4797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number098.0088779
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number000885
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: