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General NPI Number Information
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NPI Number | 1720751852
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Entity Type | Individual
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Provider Name | GABRIELLE MATYUS
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Gender | Female
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Dates
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Enumeration Date | 07/26/2021
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 1250 S CEDAR CREST BLVD
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City | ALLENTOWN
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State | PA
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Zip | 18103-6224
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Country | US
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Telephone | 610-402-6890
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Fax | 610-402-6892
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Provider Business Mailing Address
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Address Line | 121 BRUNSWICK AVE
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City | BLOOMSBURY
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State | NJ
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Zip | 08804-3020
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Country | US
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Telephone | 484-903-7097
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN691196
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | SP024603
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License Number State | PA
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