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1649860909 NPI number — NICHOLAS JACOB MATALIK

NPI Number: 1649860909
Health Care Provider/Practitioner: NICHOLAS JACOB MATALIK

Information about “1649860909” NPI (NICHOLAS JACOB MATALIK) exists in 1649860909 in HTML format HTML  |  1649860909 in plain Text format TXT  |  1649860909 in PDF (Portable Document Format) PDF  |  1649860909 in an XML format XML  formats.

NPI Number : 1649860909 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1649860909",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MATALIK",
    "FirstName": "NICHOLAS",
    "MiddleName": "JACOB",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "408 ELM ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "INDIANA",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "15701-3131",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "724-599-4060",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "647 PHILADELPHIA ST STE 303",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "INDIANA",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "15701-3923",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "724-599-4060",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/21/2021",
    "LastUpdateDate": "02/26/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "01/27/2021",
    "NPIReactivationDate": "02/26/2021",
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YP2500X",
        "TaxonomyName": "Professional Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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