Provider Demographics
NPI:1982693917
Name:MATULEWICZ, THEODORE JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:JOSEPH
Last Name:MATULEWICZ
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 1:17 ANN ST
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1403
Mailing Address - Country:US
Mailing Address - Phone:732-776-4144
Mailing Address - Fax:732-776-4146
Practice Address - Street 1:1945 STATE ROUTE 33
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4859
Practice Address - Country:US
Practice Address - Phone:732-776-4144
Practice Address - Fax:732-776-4146
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA32850207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0974148Medicaid
NJB33584Medicare UPIN
NJ0974148Medicaid