Provider Demographics
NPI:1538401955
Name:EGAN, MATTHEW C (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:EGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 E 96TH ST
Mailing Address - Street 2:APT. 3F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3839
Mailing Address - Country:US
Mailing Address - Phone:301-943-0666
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:301-943-0666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR2089207P00000X
NY283503207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine