Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS009643L | PA |
N | 207QA0401X | Family Doctor - Addiction Medicine | OS009643L | PA |
NPI | 1629057492 |
---|---|
Provider Name | Dr. Robert C Matylewicz JR. |
First Address | North Miami, FL 33161-5833 |
Second Address | Wrightsville, PA 17368-9205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 16/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0018670440004 | (05) | PA |
H54056 | (02) | PA |