Provider Demographics
NPI:1275605719
Name:MASTERSON, EDWARD P (DC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:P
Last Name:MASTERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:1200 RIVER AVE MASTERSON CHIROPRACTIC
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:732-370-3300
Mailing Address - Fax:732-370-5499
Practice Address - Street 1:1200 RIVER AVE
Practice Address - Street 2:2B
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701
Practice Address - Country:US
Practice Address - Phone:732-370-3300
Practice Address - Fax:732-370-5499
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ38MC300633000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor