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NPI Code Detail

MEDICARE: BRETT MATISAK

MEDICARE: BRETT MATISAK
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1821565730
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRETT MATISAK
Provider Business Mailing Address
First Line : 329 MAIN RD
Second Line :
City : MONTVILLE
State : NJ
Zip : 07045-9729
Country : US
Telephone Number : 973-334-9404
Fax Number : 973-334-7615
Provider Business Practice Location Address
First Line : 329 MAIN RD
Second Line :
City : MONTVILLE
State : NJ
Zip : 07045-9729
Country : US
Telephone Number : 973-334-9404
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2018
Last Update Date : 10/29/2018

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Directions to “ BRETT MATISAK ” Practice Location

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