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Individual

THOMAS W MATERNA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
20 FERRY ST, NEWARK, NJ 07105-1420
(973) 589-0104
(973) 589-5084
Mailing address
87 LORRAINE AVE, UPPER MONTCLAIR, NJ 07043-2304
(973) 744-4265

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
25MA03400000
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
061280694
TAX ID
NJ
05
1465201
NJ
Enumeration date
02/05/2007
Last updated
01/13/2014
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