Healthcare Provider Details

I. General information

NPI: 1992452171
Provider Name (Legal Business Name): MATTHEW JOSEPH KOBZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 CHEWS LANDING RD
LAUREL SPRINGS NJ
08021-2771
US

IV. Provider business mailing address

5 MORGAN TER
WHARTON NJ
07885-1027
US

V. Phone/Fax

Practice location:
  • Phone: 856-454-3104
  • Fax:
Mailing address:
  • Phone: 197-334-9771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00815300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: