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General NPI Number Information
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NPI Number | 1174859284
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Entity Type | Individual
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Provider Name | MATTHEW J NIEDZWIECKI MD
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Gender | Male
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 11332 MOUNTAIN VIEW AVE STE C
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City | LOMA LINDA
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State | CA
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Zip | 92354-3854
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Country | US
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Telephone | 401-390-6297
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Fax |
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Provider Business Mailing Address
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Address Line | 11 S MAIN ST STE 200
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City | CONCORD
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State | NH
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Zip | 03301-4846
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Country | US
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Telephone | 401-390-6297
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 22784
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C156972
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2017-01279
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | V8156
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036.130526
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA10564100
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License Number State | NJ
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Taxonomy #7
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD60749657
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License Number State | WA
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