Matrix Medical Network of New Jersey PC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

MATRIX MEDICAL NETWORK OF NEW JERSEY PC

Practice address

250 Pehle Ave Ste 200
Saddle Brook, NJ 07663-5835

Phone

(480) 862-1677

Fax

(480) 718-7643

NPI assigned

Apr 26, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stephanie Peterson

Title

Supervisor Provider Enrollment

Phone

(480) 862-1677

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588550400000",
    "number": "1831480730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9201 E MOUNTAIN VIEW #220",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852585172",
            "telephone_number": "480-862-1700",
            "fax_number": "877-506-4560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 PEHLE AVE STE 200",
            "city": "SADDLE BROOK",
            "state": "NJ",
            "postal_code": "076635835",
            "telephone_number": "480-862-1677",
            "fax_number": "480-718-7643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATRIX MEDICAL NETWORK OF NEW JERSEY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-26",
        "last_updated": "2020-05-04",
        "certification_date": "2020-05-04",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "SUPERVISOR PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "480-862-1677"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Saddle Brook, NJ
• Providers in Saddle Brook, NJ by specialty
• Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.