Provider Demographics
NPI:1245546142
Name:TERRANOVA, MATTHEW PATRICK JR (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PATRICK
Last Name:TERRANOVA
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:557 CRANBURY RD
Mailing Address - Street 2:STE 22
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5419
Mailing Address - Country:US
Mailing Address - Phone:732-613-0500
Mailing Address - Fax:732-613-0345
Practice Address - Street 1:557 CRANBURY RD
Practice Address - Street 2:SUITE 22
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5419
Practice Address - Country:US
Practice Address - Phone:732-613-0500
Practice Address - Fax:732-613-0345
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2017-02-28
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB08828000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223791Medicare PIN