Provider Demographics
NPI:1326075987
Name:MASTORIS, MICHAEL NICHOLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:NICHOLAS
Last Name:MASTORIS
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 1:226 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:HIGHTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-3224
Mailing Address - Country:US
Mailing Address - Phone:609-443-6161
Mailing Address - Fax:609-443-8904
Practice Address - Street 1:226 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HIGHTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08520-3224
Practice Address - Country:US
Practice Address - Phone:609-443-6161
Practice Address - Fax:609-443-8904
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00137000111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6643108Medicaid
NJ042669Medicare ID - Type UnspecifiedID#
NJ6643108Medicaid