Doctor Name: | DR. MICHAEL S. MATTIKOW |
NPI Number: | 1629006978 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 25MA02206300 |
Business Practice Address: | 2282 Hamburg Tpke Suite E Wayne, NJ - 074706291 |
Business Phone Number: | 9736967300 |
Business Fax Number: | 9738350520 |
Mailing Address: | 2282 Hamburg Tpke, Suite E WAYNE |
State: | NJ |
Postal Code: | 074706291 |
Phone Number: | 9736967300 |
Fax Number: | 9738350520 |
NPI Enumeration Date: | 06/28/2006 |
NPI Last Update Date: | 02/03/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 25MA02206300 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |