MEDICARE: DR. MATTHEW B. WELCH DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	MD02057	NJ

General Provider Information

NPI Number	:	1699762351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW B. WELCH DPM

Provider Business Mailing Address
First Line	:	6506 PARK AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-4302
Country	:	US
Telephone Number	:	201-662-1122
Fax Number	:	201-869-2965

Provider Business Practice Location Address
First Line	:	6506 PARK AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-4302
Country	:	US
Telephone Number	:	201-662-1122
Fax Number	:	201-869-2965

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

Provider Enumeration Date	:	09/28/2005
Last Update Date	:	07/13/2007

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