MEDICARE: MR. DONN MATTHEW HOOSACK PA-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	363A00000X	Physician Assistant	MP00132300	NJ

General Provider Information

NPI Number	:	1194777375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONN MATTHEW HOOSACK PA-C

Provider Business Mailing Address
First Line	:	2 RANCH BLVD
Second Line	:
City	:	MANAHAWKIN
State	:	NJ
Zip	:	08050-7828
Country	:	US
Telephone Number	:	609-978-2750
Fax Number	:

Provider Business Practice Location Address
First Line	:	1517 RICHMOND AVE
Second Line	:
City	:	POINT PLEASANT BEACH
State	:	NJ
Zip	:	08742-3056
Country	:	US
Telephone Number	:	732-295-6377
Fax Number	:

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	06/02/2016

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