Provider Demographics
NPI:1740357953
Name:HORVATH - MATTHEWS, JESSICA E (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:E
Last Name:HORVATH - MATTHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 EGG HARBOR RD
Mailing Address - Street 2:BUILDING 600, SUITE 604
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9406
Mailing Address - Country:US
Mailing Address - Phone:856-232-6471
Mailing Address - Fax:856-232-7028
Practice Address - Street 1:123 EGG HARBOR RD
Practice Address - Street 2:BUILDING 600, SUITE 604
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9406
Practice Address - Country:US
Practice Address - Phone:856-232-6471
Practice Address - Fax:856-232-7028
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0007638207Q00000X
NJMA08529400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000041384Medicaid
NJ25MA08529400OtherSTATE LICENSE
DE162440OtherMEDICARE GROUP NUMBER
NJ25MA08529400OtherSTATE LICENSE