Provider Demographics
NPI:1205816535
Name:RIORDAN, MATTHEW K (MSPT, OCS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:K
Last Name:RIORDAN
Suffix:
Gender:M
Credentials:MSPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2804
Mailing Address - Country:US
Mailing Address - Phone:973-270-7417
Mailing Address - Fax:973-377-1064
Practice Address - Street 1:111 KINGS RD.
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-2122
Practice Address - Country:US
Practice Address - Phone:971-270-7417
Practice Address - Fax:973-377-1064
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA010160002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ094736Medicare PIN
NJ065153PLIMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #