Provider Demographics
NPI:1407570690
Name:BATTILLO, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BATTILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 WOODMONT CT
Mailing Address - Street 2:
Mailing Address - City:MT ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07856-1450
Mailing Address - Country:US
Mailing Address - Phone:973-896-0778
Mailing Address - Fax:
Practice Address - Street 1:276 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2646
Practice Address - Country:US
Practice Address - Phone:973-664-2391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04203000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist