Provider Demographics
NPI:1447683685
Name:MATZKO, JONATHAN (DC, D-ABNM)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:MATZKO
Suffix:
Gender:M
Credentials:DC, D-ABNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 TEANECK RD
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4854
Mailing Address - Country:US
Mailing Address - Phone:201-862-9900
Mailing Address - Fax:201-862-9136
Practice Address - Street 1:16 GINTER ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NJ
Practice Address - Zip Code:07416-1710
Practice Address - Country:US
Practice Address - Phone:973-827-2473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ71246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic