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General NPI Number Information
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NPI Number | 1891706842
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Entity Type | Organization
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Legal Business Name | HILLSIDE FAMILY PRACTICE PC
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 02/03/2011
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Provider Practice Location Address
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Address Line | 100 HOLLYWOOD AVE HILLSIDE FAMILY PRACTICE
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City | HILLSIDE
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State | NJ
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Zip | 07205-2409
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Country | US
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Telephone | 908-353-7949
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Fax | 908-353-8374
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Provider Business Mailing Address
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Address Line | 100 HOLLYWOOD AVE HILLSIDE FAMILY PRACTICE
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City | HILLSIDE
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State | NJ
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Zip | 07205-2409
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Country | US
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Telephone | 908-353-7949
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Fax | 908-353-8374
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Authorized Official
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Title or Position | PRESIDENT
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Name | WALTER MATKIWSKY
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Credential | DO
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Telephone | 908-353-7949
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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 | 25MB02410900
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License Number State | NJ
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