Provider Demographics
NPI:1649403411
Name:GALITZ, MATTHEW (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:GALITZ
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 PINE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-1804
Mailing Address - Country:US
Mailing Address - Phone:973-696-3300
Mailing Address - Fax:973-317-7540
Practice Address - Street 1:499 PINE BROOK RD
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:NJ
Practice Address - Zip Code:07035-1804
Practice Address - Country:US
Practice Address - Phone:973-696-3300
Practice Address - Fax:973-317-7540
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09051100224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant