Provider Demographics
NPI:1124290598
Name:MATTHEW B. WELCH DPM
Entity type:Organization
Organization Name:MATTHEW B. WELCH DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:B
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-662-1122
Mailing Address - Street 1:6506 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-4302
Mailing Address - Country:US
Mailing Address - Phone:201-662-1122
Mailing Address - Fax:201-869-2965
Practice Address - Street 1:6506 PARK AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-4302
Practice Address - Country:US
Practice Address - Phone:201-662-1122
Practice Address - Fax:201-869-2965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00205700213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0784770001Medicare NSC