Healthcare Provider Details

I. General information

NPI: 1225001993
Provider Name (Legal Business Name): MATTHEW STEPHEN HAYES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 MADISON AVE
NEW YORK NY
10035-3832
US

IV. Provider business mailing address

1824 MADISON AVE
NEW YORK NY
10035-3832
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-4500
  • Fax: 646-770-8405
Mailing address:
  • Phone: 212-423-4500
  • Fax: 646-770-8405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1262
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number447
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2012-731
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number288256
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: