NPIMap

Organization Active NPI

Hillside Family Practice PC

  • Family Medicine Physician
  • Hillside, NJ
National Provider Identifier
1891706842
Registry record updated Feb 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25MB02410900 Issued in NJ
Legal business name
HILLSIDE FAMILY PRACTICE PC
Practice address
100 Hollywood Ave
Hillside Family Practice
Hillside, NJ 07205-2409
Phone
(908) 353-7949
Fax
(908) 353-8374
NPI assigned
Aug 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2011

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

Authorized official

Name
Walter Matkiwsky, DO
Title
President
Phone
(908) 353-7949

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 25MB02410900 NJ Primary

Addresses

Primary practice location

100 Hollywood Ave
Hillside Family Practice
Hillside, NJ 07205-2409

Mailing address

100 Hollywood Ave
Hillside Family Practice
Hillside, NJ 07205-2409
Phone (908) 353-7949

Other identifiers 1

IdentifierTypeStateIssuer
0048071MedicaidNJ

National Provider Directory

National Provider Directory

Locations

100 Hollywood Ave
Hillside, NJ 07205
Phone (908) 353-7949

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296691200000",
    "number": "1891706842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HOLLYWOOD AVE",
            "address_2": "HILLSIDE FAMILY PRACTICE",
            "city": "HILLSIDE",
            "state": "NJ",
            "postal_code": "072052409",
            "telephone_number": "908-353-7949",
            "fax_number": "908-353-8374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HOLLYWOOD AVE",
            "address_2": "HILLSIDE FAMILY PRACTICE",
            "city": "HILLSIDE",
            "state": "NJ",
            "postal_code": "072052409",
            "telephone_number": "908-353-7949",
            "fax_number": "908-353-8374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HILLSIDE FAMILY PRACTICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2011-02-03",
        "status": "A",
        "authorized_official_last_name": "MATKIWSKY",
        "authorized_official_first_name": "WALTER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "908-353-7949",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB02410900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0048071",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hillside, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2011; 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.