Provider Demographics
NPI:1184942351
Name:LOBEL, MATT
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:LOBEL
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 1:14 SOUTH CENRE STREET
Mailing Address - Street 2:
Mailing Address - City:MERCHANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14 SOUTH CENRE STREET
Practice Address - Street 2:
Practice Address - City:MERCHANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08109
Practice Address - Country:US
Practice Address - Phone:856-663-1038
Practice Address - Fax:856-663-1568
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02627700183500000X
PA12815517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist