Provider Demographics
NPI:1578896072
Name:CAMKALLLC
Entity Type:Organization
Organization Name:CAMKALLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:N
Authorized Official - Last Name:MATTIELLO EGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-714-1846
Mailing Address - Street 1:9 MASON AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-1623
Mailing Address - Country:US
Mailing Address - Phone:973-686-1982
Mailing Address - Fax:
Practice Address - Street 1:9 MASON AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:NJ
Practice Address - Zip Code:07035-1623
Practice Address - Country:US
Practice Address - Phone:973-686-1982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00469300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty