Healthcare Provider Details

I. General information

NPI: 1346810330
Provider Name (Legal Business Name): MATTHEW JAMES MACDONALD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTHEAST REGIONAL EPILEPSY GROUP 20 PROSPECT AVE SUITE 800
HACKENSACK NJ
07601
US

IV. Provider business mailing address

NORTHEAST REGIONAL EPILEPSY GROUP 20 PROSPECT AVE SUITE 800
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 201-343-6676
  • Fax: 201-343-6689
Mailing address:
  • Phone: 201-343-6676
  • Fax: 201-343-6689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number341624
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: