Provider Demographics
NPI:1093869463
Name:MASTROTI, JEAN BAPTISTE J (MD)
Entity Type:Individual
Prefix:MR
First Name:JEAN BAPTISTE
Middle Name:J
Last Name:MASTROTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036
Mailing Address - Country:US
Mailing Address - Phone:908-587-1593
Mailing Address - Fax:
Practice Address - Street 1:595 COUNTY AVE
Practice Address - Street 2:MEADOWVIEW PSYCH HOSPITAL
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094
Practice Address - Country:US
Practice Address - Phone:201-319-3667
Practice Address - Fax:201-319-3616
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0629142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
686031A0G6Medicare ID - Type Unspecified
G43714Medicare UPIN