Individual
DR. MICHAEL J. MATARESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
116 TERRACE AVE, LODI, NJ 07644-2905
(973) 473-3896
Mailing address
116 TERRACE AVE, LODI, NJ 07644-2905
(973) 473-3896
(973) 473-4806
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA10464200
NJ
207RP1001X
Pulmonary Disease Physician
144046
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00891121
—
NY
Enumeration date
01/17/2007
Last updated
01/24/2019
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