MEDICARE: FRANK MATUSIK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1255561429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANK MATUSIK

Provider Business Mailing Address
First Line	:	800 ROUTE 9
Second Line	:
City	:	BAYVILLE
State	:	NJ
Zip	:	08721-3068
Country	:	US
Telephone Number	:	732-606-1119
Fax Number	:	732-606-1802

Provider Business Practice Location Address
First Line	:	800 ROUTE 9
Second Line	:
City	:	BAYVILLE
State	:	NJ
Zip	:	08721-3068
Country	:	US
Telephone Number	:	732-606-1119
Fax Number	:	732-606-1802

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	07/21/2009

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