Basic Information
| Provider Information | |||||||||
| NPI: | 1134598618 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUDEK | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 76 STIRLING RD | ||||||||
| Address2: | STE 400 | ||||||||
| City: | WARREN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070595778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082515888 | ||||||||
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| Practice Location | |||||||||
| Address1: | 505 MORRIS AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070811037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9733797006 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2015 | ||||||||
| LastUpdateDate: | 09/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01626200 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.