ROMAN MATSOUK PA-C NPI 1558422766

NPI Information

NPI: 1558422766
Provider Name: ROMAN MATSOUK, PA-C
Classification: Physician Assistant - 363AS0400X
Specialization: Surgical
Entity Type: Individual
PECOS Registration: Yes
Address: 695 US HIGHWAY 46
SUITE 400A
FAIRFIELD, NJ
ZIP 07004
Phone: (973) 826-8080

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NPI Details

Roman Matsouk, PA-C is a surgical physician assistant in Fairfield, NJ. Roman Matsouk, PA-C NPI is 1558422766. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

695 US HIGHWAY 46
SUITE 400A
FAIRFIELD, NJ
ZIP 07004-592
Phone: (973) 826-8080
Fax: (866) 309-3354

The NPI 1558422766 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

Repair of groin hernia using an endoscope (HCPCS:49650)

The enumeration date for this NPI number is 12/12/2006 and was last updated on 5/21/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363A00000X	Physician Assistant		2SMP00172500	NEW JERSEY	No
2	363AS0400X	Physician Assistant	Surgical	011450-1	NEW YORK	Yes
3	363AS0400X	Physician Assistant	Surgical	25MP00172500	NEW JERSEY	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0429294	MEDICAID	NEW JERSEY
2	116532ZJ5N	OTHER	NEW JERSEY	PTAN SURGERY SERVICES
3	116532YP69	OTHER	NEW JERSEY	PTAN QUALITY SURGICAL SERVICES

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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