Provider Demographics
NPI:1346353208
Name:CASSELLS, MATTHEW P (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:CASSELLS
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MAIN ST
Mailing Address - Street 2:NEW JERSEY SPINE CENTER
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2431
Mailing Address - Country:US
Mailing Address - Phone:973-635-0800
Mailing Address - Fax:973-635-6254
Practice Address - Street 1:40 MAIN ST
Practice Address - Street 2:NEW JERSEY SPINE CENTER
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2431
Practice Address - Country:US
Practice Address - Phone:973-635-0800
Practice Address - Fax:973-635-6254
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMP207363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ478750B9MMedicare ID - Type Unspecified
S30708Medicare UPIN