Provider Demographics
NPI:1508978917
Name:MATONTI, ALAN EARL (LCADC)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:EARL
Last Name:MATONTI
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BRIARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-2014
Mailing Address - Country:US
Mailing Address - Phone:732-291-7997
Mailing Address - Fax:
Practice Address - Street 1:30 BRIARWOOD AVE
Practice Address - Street 2:51 MEMORIAL PARKWAY
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-2014
Practice Address - Country:US
Practice Address - Phone:732-291-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
NJ37LC00037100171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor