Provider Demographics
NPI:1366618902
Name:MATOS, ANNAMARIE (NP-C)
Entity type:Individual
Prefix:
First Name:ANNAMARIE
Middle Name:
Last Name:MATOS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 JAY AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1408
Mailing Address - Country:US
Mailing Address - Phone:973-670-4615
Mailing Address - Fax:
Practice Address - Street 1:156 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2016
Practice Address - Country:US
Practice Address - Phone:973-926-8491
Practice Address - Fax:973-923-6599
Is Sole Proprietor?:No
Enumeration Date:2008-05-04
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00153400363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health