Provider Demographics
NPI:1811195720
Name:MATORIN, AMY B (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:MATORIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:BETH
Other - Last Name:YOUCHNOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4 HARDING CT
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2452
Mailing Address - Country:US
Mailing Address - Phone:609-448-8510
Mailing Address - Fax:
Practice Address - Street 1:903 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5515
Practice Address - Country:US
Practice Address - Phone:215-579-6155
Practice Address - Fax:215-860-0723
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP0054300363A00000X
PAMA054653363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ113656C6VMedicare PIN