Provider Demographics
NPI:1821565730
Name:MATISAK, BRETT
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:MATISAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9729
Mailing Address - Country:US
Mailing Address - Phone:973-334-9404
Mailing Address - Fax:973-334-7615
Practice Address - Street 1:329 MAIN RD
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9729
Practice Address - Country:US
Practice Address - Phone:973-334-9404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst