Provider Demographics
NPI:1548983612
Name:WESTLAKE, MATTHEW J (CO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:WESTLAKE
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1139
Mailing Address - Country:US
Mailing Address - Phone:201-370-5423
Mailing Address - Fax:
Practice Address - Street 1:901 45TH STREET
Practice Address - Street 2:KIMMEL BUILDING
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407
Practice Address - Country:US
Practice Address - Phone:561-405-8267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45OR00007500222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty