Healthcare Provider Details

I. General information

NPI: 1093844532
Provider Name (Legal Business Name): MATTHEW BARTELS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 FORT WASHINGTON AVE SUITE 199
NEW YORK NY
10032-3735
US

IV. Provider business mailing address

630 W 168TH ST #38
NEW YORK NY
10032-3725
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-0483
  • Fax: 212-342-6852
Mailing address:
  • Phone: 212-305-0483
  • Fax: 212-342-6852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number187331-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: