Provider Demographics
NPI:1487622247
Name:MATICAN, JEFFREY STEVEN (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:STEVEN
Last Name:MATICAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 ENGLE ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1824
Mailing Address - Country:US
Mailing Address - Phone:201-503-1920
Mailing Address - Fax:201-503-0222
Practice Address - Street 1:309 ENGLE ST
Practice Address - Street 2:SUITE 5
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1824
Practice Address - Country:US
Practice Address - Phone:201-503-1920
Practice Address - Fax:201-503-0222
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA5491700207RI0011X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0460800Medicaid
NJ609198Medicare ID - Type Unspecified
NJ0460800Medicaid