Basic Information
| Provider Information | |||||||||
| NPI: | 1528005881 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATZA | ||||||||
| FirstName: | ILENE | ||||||||
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| Credential: | A.P.N | ||||||||
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| Mailing Information | |||||||||
| Address1: | 703 MAIN ST | ||||||||
| Address2: | ST. JOSEPH'S REGIONAL MEDICAL CENTER | ||||||||
| City: | PATERSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 075032621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737543084 | ||||||||
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| Practice Location | |||||||||
| Address1: | 703 MAIN ST | ||||||||
| Address2: | ST. JOSEPH'S REGIONAL MEDICAL CENTER | ||||||||
| City: | PATERSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 075032621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737542000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 10/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 26NJ00040500 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | P3650149 | 01 | NJ | OXFORD | OTHER | 2K9807 | 01 | NJ | HEALTH NET | OTHER |