Provider Demographics
NPI:1720113350
Name:ABAD, MATTHEW ALFEROS
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALFEROS
Last Name:ABAD
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 1:1104 S BURNT MILL RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2217
Mailing Address - Country:US
Mailing Address - Phone:856-520-1510
Mailing Address - Fax:
Practice Address - Street 1:318 N LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-1018
Practice Address - Country:US
Practice Address - Phone:610-259-3385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00175900363A00000X
MA053964363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant