Healthcare Provider Details

I. General information

NPI: 1528845963
Provider Name (Legal Business Name): EMALY MATARI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 PROSPECT AVE
HACKENSACK NJ
07601-2519
US

IV. Provider business mailing address

306 SHADES OF DEATH RD
GREAT MEADOWS NJ
07838-2609
US

V. Phone/Fax

Practice location:
  • Phone: 551-309-3555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: