Provider Demographics
NPI:1447336771
Name:MATALKAH, NIDAL (MD)
Entity type:Individual
Prefix:MR
First Name:NIDAL
Middle Name:
Last Name:MATALKAH
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:PO BOX 2336
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-595-7456
Mailing Address - Fax:973-904-9119
Practice Address - Street 1:401 HAMBURG TPKE
Practice Address - Street 2:SUITE 107
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2154
Practice Address - Country:US
Practice Address - Phone:973-595-7456
Practice Address - Fax:973-904-9119
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA061937207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6826407Medicaid
NJ858357Medicare ID - Type Unspecified
NJ6826407Medicaid