Provider Demographics
NPI:1013260710
Name:OPPEDISANO, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:OPPEDISANO
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 1:773 E ROUTE 70
Mailing Address - Street 2:SUITE E130
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2362
Mailing Address - Country:US
Mailing Address - Phone:856-988-7999
Mailing Address - Fax:856-988-8858
Practice Address - Street 1:773 E ROUTE 70
Practice Address - Street 2:SUITE E130
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2362
Practice Address - Country:US
Practice Address - Phone:856-988-7999
Practice Address - Fax:856-988-8858
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist