Provider Demographics
NPI:1053534198
Name:DR MATIENZO HEALTH CARE PA
Entity type:Organization
Organization Name:DR MATIENZO HEALTH CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATIENZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-659-0711
Mailing Address - Street 1:450 7TH ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2057
Mailing Address - Country:US
Mailing Address - Phone:201-659-0711
Mailing Address - Fax:201-659-4117
Practice Address - Street 1:450 7TH ST
Practice Address - Street 2:SUITE 9
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2057
Practice Address - Country:US
Practice Address - Phone:201-659-0711
Practice Address - Fax:201-659-4117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA075238207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ066930Medicare ID - Type Unspecified
NJH78007Medicare UPIN