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General NPI Number Information
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NPI Number | 1033154463
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Entity Type | Individual
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Provider Name | GARY MATUSOW DO
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Gender | Male
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 3205 FIRE RD
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City | EGG HARBOR TOWNSHIP
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State | NJ
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Zip | 08234-5857
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Country | US
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Telephone | 609-407-1220
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Fax | 321-280-2479
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Provider Business Mailing Address
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Address Line | 3205 FIRE RD
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City | EGG HARBOR TOWNSHIP
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State | NJ
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Zip | 08234-5857
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Country | US
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Telephone | 609-407-1220
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Fax | 321-280-2479
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MB05205400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 25MB05205400
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License Number State | NJ
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