Individual
DR. MATHEW SHANE MAURER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
622 W 168TH ST, NEW YORK, NY 10032-3720
(212) 305-9808
Mailing address
630 W 168TH ST, BOX 4, NEW YORK, NY 10032-3725
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
194999
NY
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
Primary
194999
NY
207RC0000X
Cardiovascular Disease Physician
194999
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01947662
—
NY
Enumeration date
11/21/2006
Last updated
04/23/2020
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