Provider Demographics
NPI:1710158365
Name:MATTIE, JAMES KENNETH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KENNETH
Last Name:MATTIE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HERITAGE CT
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07438-9127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 HERITAGE CT
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07438-9127
Practice Address - Country:US
Practice Address - Phone:973-208-7145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program