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General NPI Number Information
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NPI Number | 1629057492
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Entity Type | Individual
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Provider Name | ROBERT C MATYLEWICZ JR. D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/11/2006
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 1166 HILTS ROAD
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City | WRIGHTSVILLE
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State | PA
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Zip | 17368-9205
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Country | US
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Telephone | 888-852-6672
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Fax | 305-891-4228
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Provider Business Mailing Address
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Address Line | 1065 NE 125TH STREET SUITE 300
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City | NORTH MIAMI
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State | FL
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Zip | 33161-5833
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Country | US
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Telephone | 888-852-6672
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Fax | 305-891-4228
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS009643L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | OS009643L
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License Number State | PA
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