Healthcare Provider Details

I. General information

NPI: 1326069733
Provider Name (Legal Business Name): MATTHEW J. WILLENKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 S LENOLA RD
MOORESTOWN NJ
08057-1561
US

IV. Provider business mailing address

2201 HEMPSTEAD TPKE
EAST MEADOW NY
11554-1859
US

V. Phone/Fax

Practice location:
  • Phone: 800-380-0111
  • Fax:
Mailing address:
  • Phone: 165-726-8035
  • Fax: 516-572-5019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA12780700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: