Provider Demographics
NPI:1871551937
Name:MATZEK, JILL (RPA-C)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MATZEK
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10869 RTE 36 SOUTH
Mailing Address - Street 2:PO BOX 601
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-0601
Mailing Address - Country:US
Mailing Address - Phone:585-335-3416
Mailing Address - Fax:585-335-8695
Practice Address - Street 1:60 RED JACKET ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-0339
Practice Address - Country:US
Practice Address - Phone:585-335-6041
Practice Address - Fax:585-335-6764
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007184363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03482299Medicaid
NYCC1076Medicare PIN
NYP00336510Medicare PIN
NYP09668Medicare UPIN