Healthcare Provider Details

I. General information

NPI: 1366652596
Provider Name (Legal Business Name): MATRIX MEDICAL GROUP, P,C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 PALISADE AVE
JERSEY CITY NJ
07306-1121
US

IV. Provider business mailing address

201 PALISADE AVE
JERSEY CITY NJ
07306-1112
US

V. Phone/Fax

Practice location:
  • Phone: 201-985-1850
  • Fax:
Mailing address:
  • Phone: 201-985-1850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MANUEL BORJA
Title or Position: CHAIRPERSON
Credential: M.D.
Phone: 201-985-1850