Provider Demographics
NPI:1275697104
Name:MASTROBATTISTA, JONATHAN P (DC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:P
Last Name:MASTROBATTISTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ANDERSON HILL ROAD
Mailing Address - Street 2:THE CARRAIGE HOUSE
Mailing Address - City:BERNARDSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07924-2323
Mailing Address - Country:US
Mailing Address - Phone:908-766-3943
Mailing Address - Fax:
Practice Address - Street 1:10 ANDERSON HILL RD
Practice Address - Street 2:
Practice Address - City:BERNARDSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07924-2323
Practice Address - Country:US
Practice Address - Phone:908-766-3943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ518568Medicare PIN