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General NPI Number Information
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NPI Number | 1538629225
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Entity Type | Individual
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Provider Name | MATTHEW STRAIGHT MD
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Gender | Male
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Dates
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Enumeration Date | 03/20/2019
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Last Update Date | 07/05/2024
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Provider Practice Location Address
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Address Line | 622 W 168TH ST STE VC260
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City | NEW YORK
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State | NY
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Zip | 10032-3720
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Country | US
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Telephone | 646-317-4590
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Fax |
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Provider Business Mailing Address
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Address Line | 1 GUSTAVE L LEVY PL
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City | NEW YORK
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State | NY
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Zip | 10029-6504
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Country | US
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Telephone | 212-241-6500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 322884
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 322884
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License Number State | NY
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