Provider Demographics
NPI:1336188473
Name:MATTES, DAVID G (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:MATTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:997 FAIRVIEW LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-4007
Mailing Address - Country:US
Mailing Address - Phone:973-579-7703
Mailing Address - Fax:
Practice Address - Street 1:181 HIGH ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1020
Practice Address - Country:US
Practice Address - Phone:973-383-9898
Practice Address - Fax:973-383-9665
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04836900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1011592Medicaid
NJMA153408Medicare ID - Type Unspecified
NJ1011592Medicaid