Provider Demographics
NPI:1841204559
Name:MATKIWSKY, DANIEL WALTER (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:WALTER
Last Name:MATKIWSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:406 ROUTE 23 STE 1
Practice Address - Street 2:SKAYLANDS MEDICAL GROUP
Practice Address - City:FRANKLIN
Practice Address - State:NJ
Practice Address - Zip Code:07416-2132
Practice Address - Country:US
Practice Address - Phone:973-827-2120
Practice Address - Fax:973-827-9445
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06902500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0048062Medicaid
H21787Medicare UPIN
NJ0048062Medicaid