Provider Demographics
NPI:1578632576
Name:GAVZY, MATTHEW SETH (PTA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:SETH
Last Name:GAVZY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11-06 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1700
Mailing Address - Country:US
Mailing Address - Phone:201-797-1917
Mailing Address - Fax:
Practice Address - Street 1:1086 TEANECK RD
Practice Address - Street 2:SUITE 3E
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4854
Practice Address - Country:US
Practice Address - Phone:201-833-1333
Practice Address - Fax:201-833-1390
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00238900225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant