Provider Demographics
NPI:1790503977
Name:EVDOKAS, MATTEO FRANCIS (DPT, PT)
Entity type:Individual
Prefix:
First Name:MATTEO
Middle Name:FRANCIS
Last Name:EVDOKAS
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 WILLOW TER
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2812
Mailing Address - Country:US
Mailing Address - Phone:201-707-8135
Mailing Address - Fax:
Practice Address - Street 1:5 MARINE VIEW PLZ
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5756
Practice Address - Country:US
Practice Address - Phone:201-683-8058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02286100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist