Provider Demographics
NPI:1518917608
Name:MATEJICKA, ANTHONY (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:MATEJICKA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 N MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1912
Mailing Address - Country:US
Mailing Address - Phone:845-348-2198
Mailing Address - Fax:845-348-3073
Practice Address - Street 1:160 N MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1912
Practice Address - Country:US
Practice Address - Phone:845-348-2198
Practice Address - Fax:845-348-3073
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008854L207R00000X
NY283862207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50878OtherGEISINGER HEALTH PLAN
PA130641OtherTHREE RIVERS/UNISON
PA975368OtherAMERIHEALTH (IBC)
PA975368OtherHIGHMARK BLUE SHIELD
PAP004445OtherGATEWAY HEALTH PLAN
PA50001305OtherCAPITAL BLUE CROSS
PA975368OtherKEYSTONE CENTRAL
PA2751467OtherAETNA
PAG71084Medicare UPIN
PA009762Medicare ID - Type Unspecified
PA0679716000OtherKEYSTONE EAST
PA20014082OtherAMERIHEALTH MERCY
PAP2843092OtherOXFORD HEALTH PLAN