Healthcare Provider Details

I. General information

NPI: 1871551937
Provider Name (Legal Business Name): JILL MATZEK RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 RED JACKET ST STE 1
DANSVILLE NY
14437-1769
US

IV. Provider business mailing address

10869 STATE ROUTE 36
DANSVILLE NY
14437-9444
US

V. Phone/Fax

Practice location:
  • Phone: 585-335-6041
  • Fax: 585-335-6764
Mailing address:
  • Phone: 585-335-3100
  • Fax: 585-335-8695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number007184
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: