Provider Demographics
NPI:1730107939
Name:MATOS-CLOKE, SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MATOS-CLOKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BERGEN STREET
Mailing Address - Street 2:BUILDING 12 ROOM 1205
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-3000
Mailing Address - Country:US
Mailing Address - Phone:973-972-0037
Mailing Address - Fax:973-972-0743
Practice Address - Street 1:230 E. RIDGEWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-967-4000
Practice Address - Fax:201-967-4117
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164031207R00000X
NJ25MA05474400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00665274Medicaid
527245OtherMEDICARE GROUP PROVIDER N
D91933Medicare UPIN
NY00665274Medicaid
D91933Medicare UPIN