MEDICARE: MATTHEW PROSPERO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1174317333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW PROSPERO MD

Provider Business Mailing Address
First Line	:	408 W 129TH ST APT 11
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-2760
Country	:	US
Telephone Number	:	915-309-0787
Fax Number	:

Provider Business Practice Location Address
First Line	:	622 W 168TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3720
Country	:	US
Telephone Number	:	915-309-0787
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2025
Last Update Date	:	03/18/2026

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Directions to “ MATTHEW PROSPERO MD” Practice Location

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