Provider Demographics
NPI:1093030454
Name:MATAWAN MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:MATAWAN MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHABRAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-970-6161
Mailing Address - Street 1:158 MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-4104
Mailing Address - Country:US
Mailing Address - Phone:732-970-6161
Mailing Address - Fax:732-970-6163
Practice Address - Street 1:158 MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-4104
Practice Address - Country:US
Practice Address - Phone:732-970-6161
Practice Address - Fax:732-970-6163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08392800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0222453Medicaid