Provider Demographics
NPI:1245362557
Name:MATTHEW S COONS MD
Entity type:Organization
Organization Name:MATTHEW S COONS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:COONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-810-8527
Mailing Address - Street 1:2333 MORRIS AVE
Mailing Address - Street 2:SUITE C-16
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5714
Mailing Address - Country:US
Mailing Address - Phone:908-810-8527
Mailing Address - Fax:
Practice Address - Street 1:2333 MORRIS AVE
Practice Address - Street 2:SUITE C-16
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5714
Practice Address - Country:US
Practice Address - Phone:908-810-8527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA640192086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7694OtherHORIZON
NJ7002106Medicaid
NJ885132Medicare PIN
NJ7694OtherHORIZON