Provider Demographics
NPI:1730411323
Name:WASIK, MATTHEW B
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:B
Last Name:WASIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 MACGREGOR PINES DR
Mailing Address - Street 2:206
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6036
Mailing Address - Country:US
Mailing Address - Phone:336-202-3170
Mailing Address - Fax:866-903-7036
Practice Address - Street 1:160 MACGREGOR PINES DR
Practice Address - Street 2:206
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6036
Practice Address - Country:US
Practice Address - Phone:336-202-3170
Practice Address - Fax:866-903-7036
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other