MEDICARE: MATT SZKOLA

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	2255A2300X	Athletic Trainer	S97575298306954	NJ

General Provider Information

NPI Number	:	1710427554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATT SZKOLA

Provider Business Mailing Address
First Line	:	65 OAKLAND AVE
Second Line	:
City	:	ROCKAWAY
State	:	NJ
Zip	:	07866-1910
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 OAKLAND AVE
Second Line	:
City	:	ROCKAWAY
State	:	NJ
Zip	:	07866-1910
Country	:	US
Telephone Number	:	973-294-2049
Fax Number	:

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

Provider Enumeration Date	:	02/27/2017
Last Update Date	:	02/27/2017

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