Provider Demographics
NPI:1952490690
Name:JEFFREY S. MATICAN, M.D., P.A.
Entity Type:Organization
Organization Name:JEFFREY S. MATICAN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MATICAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-503-1920
Mailing Address - Street 1:309 ENGLE ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1824
Mailing Address - Country:US
Mailing Address - Phone:201-503-1920
Mailing Address - Fax:201-503-0222
Practice Address - Street 1:309 ENGLE ST
Practice Address - Street 2:SUITE 5
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1824
Practice Address - Country:US
Practice Address - Phone:201-503-1920
Practice Address - Fax:201-503-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA54917174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty