Individual
ROMAN MATSOUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
695 US HIGHWAY 46, SUITE 400A, FAIRFIELD, NJ 07004-1592
(973) 826-8080
(866) 309-3354
Mailing address
PO BOX 4059, WAYNE, NJ 07474-4059
(973) 826-8080
(866) 309-3354
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2SMP00172500
NJ
363AS0400X
Surgical Physician Assistant
Primary
011450-1
NY
363AS0400X
Surgical Physician Assistant
25MP00172500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0429294
—
NJ
01
—
116532YP69
PTAN QUALITY SURGICAL SERVICES
NJ
01
—
116532ZJ5N
PTAN SURGERY SERVICES
NJ
Enumeration date
12/12/2006
Last updated
05/21/2019
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