Provider Demographics
NPI:1548234099
Name:COONS, MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:COONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 419430
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-9430
Mailing Address - Country:US
Mailing Address - Phone:201-967-8221
Mailing Address - Fax:201-483-2242
Practice Address - Street 1:311 BAY AVE
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1607
Practice Address - Country:US
Practice Address - Phone:908-810-8550
Practice Address - Fax:908-810-8501
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA64019208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH223532570OtherANTHEM
TX7002106Medicaid
NJ250010283OtherMEDICARE RAILROAD
NJ250010283OtherMEDICARE RAILROAD
NJ885132Medicare PIN