Active NPI
Jorge Matta
- Neurology Physician
- Bronx, NY
National Provider Identifier
1881221752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 345387
- Practice address
- 111 E 210TH St
Bronx, NY 10467-2401 - Phone
- (718) 920-9892
- NPI assigned
- Mar 23, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurocritical Care Physician | 2084A2900X | 345387 | NY | |
| Neurology Physician | 2084N0400X | 345387 | NY | Primary |
Addresses
Primary practice location
111 E 210TH St
Bronx, NY 10467-2401
Mailing address
111 E 210TH St
Bronx, NY 10467-2401
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220629002371 | CA | Order and Referring Only - Neurology | 9537549191 |
Care Compare profile
Medicare Care Compare- Specialty
- Neurology
- Education
- Other, 2020
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
330 N Jackson St
Apt 124
Glendale, CA 91206-3609
41 E Post Rd
White Plains, NY 10601-4607
PO Box
Suite 2000
East Syracuse, NY 13057
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783382400000",
"number": "1881221752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 E 210TH ST",
"city": "BRONX",
"state": "NY",
"postal_code": "104672401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 E 210TH ST",
"city": "BRONX",
"state": "NY",
"postal_code": "104672401",
"telephone_number": "718-920-9892"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTA",
"first_name": "JORGE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-03-23",
"last_updated": "2026-07-07",
"certification_date": "2026-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "2084A2900X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurocritical Care",
"state": "NY",
"license": "345387",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "NY",
"license": "345387",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.