Provider Demographics
NPI:1699762351
Name:WELCH, MATTHEW B (DPM)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:B
Last Name:WELCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD02057213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU19485Medicare UPIN