Provider Demographics
NPI:1881614113
Name:MATILSKY, MERNA KAREN (MD)
Entity type:Individual
Prefix:DR
First Name:MERNA
Middle Name:KAREN
Last Name:MATILSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 N MILITARY TRL # 245
Mailing Address - Street 2:SUITE 245
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6365
Mailing Address - Country:US
Mailing Address - Phone:561-994-2007
Mailing Address - Fax:561-994-2003
Practice Address - Street 1:2900 N MILITARY TRL # 245
Practice Address - Street 2:SUITE 245
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6365
Practice Address - Country:US
Practice Address - Phone:561-994-2007
Practice Address - Fax:561-994-2003
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0076956207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H36403Medicare UPIN
FLE5511YMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE