Provider Demographics
NPI:1326339565
Name:MATUSZKIEWICZ, EWA
Entity Type:Individual
Prefix:
First Name:EWA
Middle Name:
Last Name:MATUSZKIEWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 LOCUST AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WALLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07057-1300
Mailing Address - Country:US
Mailing Address - Phone:973-777-6777
Mailing Address - Fax:973-777-6577
Practice Address - Street 1:42 LOCUST AVE STE 1
Practice Address - Street 2:
Practice Address - City:WALLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07057-1300
Practice Address - Country:US
Practice Address - Phone:973-777-6777
Practice Address - Fax:973-777-6577
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022343001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics