Provider Demographics
NPI:1518929736
Name:MATZO, JACQUELINE F (O D)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:F
Last Name:MATZO
Suffix:
Gender:F
Credentials:O D
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:F
Other - Last Name:ROSENHECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2220 ROUTE 9 S
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3333
Mailing Address - Country:US
Mailing Address - Phone:732-780-0088
Mailing Address - Fax:732-780-0374
Practice Address - Street 1:67 MONMOUTH RD
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-1630
Practice Address - Country:US
Practice Address - Phone:732-263-0440
Practice Address - Fax:732-571-6161
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00477700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1546882OtherUNITED HEALTHCARE
NJP1893860OtherOXFORD
NJ41130OtherAETNA
NJP1893860OtherOXFORD
NJ065120TPPMedicare ID - Type Unspecified