Provider Demographics
NPI:1649860909
Name:MATALIK, NICHOLAS JACOB
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JACOB
Last Name:MATALIK
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 1:408 ELM ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3131
Mailing Address - Country:US
Mailing Address - Phone:724-599-4060
Mailing Address - Fax:
Practice Address - Street 1:647 PHILADELPHIA ST STE 303
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3923
Practice Address - Country:US
Practice Address - Phone:724-599-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-02-26
Deactivation Date:2021-01-27
Deactivation Code:
Reactivation Date:2021-02-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional