MEDICARE: DAN MATZ

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	207V00000X	Obstetrics & Gynecology Physician	223794	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861551764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAN MATZ

Provider Business Mailing Address
First Line	:	80 MARCUS DR
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-4230
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11120 MERRICK BLVD
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11433-4016
Country	:	US
Telephone Number	:	718-206-9888
Fax Number	:

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/08/2007

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Directions to “ DAN MATZ ” Practice Location

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