Healthcare Provider Details

I. General information

NPI: 1881614113
Provider Name (Legal Business Name): MERNA KAREN MATILSKY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N MILITARY TRL # 245 SUITE 245
BOCA RATON FL
33431-6365
US

IV. Provider business mailing address

2900 N MILITARY TRL # 245 SUITE 245
BOCA RATON FL
33431-6365
US

V. Phone/Fax

Practice location:
  • Phone: 561-994-2007
  • Fax: 561-994-2003
Mailing address:
  • Phone: 561-994-2007
  • Fax: 561-994-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0076956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: