Provider Demographics
NPI:1740568997
Name:CHIN, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:CHIN
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 1:15 SPLIT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:573 VALLEY RD STE 4A
Practice Address - Street 2:4A
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3552
Practice Address - Country:US
Practice Address - Phone:973-696-0170
Practice Address - Fax:973-696-0170
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02451600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist