MEDICARE: WENDY MATUS C.A., L.A.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	25MZ00039400	NJ

General Provider Information

NPI Number	:	1053533661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY MATUS C.A., L.A.C.

Provider Business Mailing Address
First Line	:	323 BERGEN BLVD
Second Line	:
City	:	FAIRVIEW
State	:	NJ
Zip	:	07022-1334
Country	:	US
Telephone Number	:	201-945-9993
Fax Number	:	201-945-8873

Provider Business Practice Location Address
First Line	:	323 BERGEN BLVD
Second Line	:
City	:	FAIRVIEW
State	:	NJ
Zip	:	07022-1334
Country	:	US
Telephone Number	:	201-945-9993
Fax Number	:	201-945-8873

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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