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General NPI Number Information
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NPI Number | 1104276542
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Entity Type | Individual
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Provider Name | DR. MATTHEW MACKOWSKY
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Gender | Male
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 225 WILLIAMSON ST
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City | ELIZABETH
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State | NJ
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Zip | 07202-3625
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Country | US
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Telephone | 908-994-5738
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Fax |
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Provider Business Mailing Address
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Address Line | 379 CAMPUS DR
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City | SOMERSET
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State | NJ
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Zip | 08873-1161
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Country | US
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Telephone | 732-937-8939
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Fax | 732-418-8372
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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 | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | MC-2472
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 01092242A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MA11200600
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 92472
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License Number State | GA
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