Healthcare Provider Details

I. General information

NPI: 1780999201
Provider Name (Legal Business Name): MATHEW THOMAS MURIKAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CAPITAL WAY
PENNINGTON NJ
08534-2520
US

IV. Provider business mailing address

822 KUMHO DR STE 202
FAIRLAWN OH
44333-5105
US

V. Phone/Fax

Practice location:
  • Phone: 609-303-4000
  • Fax:
Mailing address:
  • Phone: 330-576-0500
  • Fax: 330-576-0467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.121202
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.121202
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA09987700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: