Basic Information
| Provider Information | |||||||||
| NPI: | 1447321476 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATARI | ||||||||
| FirstName: | HUSSEIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1126 S 70TH STREET | ||||||||
| Address2: | SUITE N500 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144554780 | ||||||||
| FaxNumber: | 4144752936 | ||||||||
| Practice Location | |||||||||
| Address1: | 308 WILLOW AVENUE | ||||||||
| Address2: | |||||||||
| City: | HOBOKEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014181820 | ||||||||
| FaxNumber: | 2014181822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 01/18/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 25MA04475500 | NJ | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 167048 | NY | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1660501 | 05 | NJ | MEDICAID | 01439261 | 05 | NY | MEDICAID |