Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 21976 | MS |
N | 207X00000X | Orthopaedic Surgeon | 25MA09281400 | NJ |
N | 207X00000X | Orthopaedic Surgeon | 268312-1 | NY |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 25MA09281400 | NJ |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 268312-1 | NY |
NPI | 1023379203 |
---|---|
Provider Name | Matthew Alan Wert |
First Address | Brooklyn, NY 11215-7247 |
Second Address | Brooklyn, NY 11215-7247 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2012 |
Last Update Date | 27/01/2017 |