Provider Demographics
NPI:1891857306
Name:MICHAEL S. MATTIKOW, M.D., P.A.
Entity Type:Organization
Organization Name:MICHAEL S. MATTIKOW, M.D., P.A.
Other - Org Name:ALLERGY & ASTHMA INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MATTIKOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-696-7300
Mailing Address - Street 1:2282 HAMBURG TPKE
Mailing Address - Street 2:STE E
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6291
Mailing Address - Country:US
Mailing Address - Phone:973-696-7300
Mailing Address - Fax:973-835-0520
Practice Address - Street 1:2282 HAMBURG TPKE
Practice Address - Street 2:STE E
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6291
Practice Address - Country:US
Practice Address - Phone:973-696-7300
Practice Address - Fax:973-835-0520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02206300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
119778Medicare PIN
C56737Medicare UPIN