Provider Demographics
NPI:1457562449
Name:FRANK P. MATTEACE MD, PA
Entity Type:Organization
Organization Name:FRANK P. MATTEACE MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MATTEACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-506-6868
Mailing Address - Street 1:567 FISCHER BLVD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-6311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:567 FISCHER BLVD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-6311
Practice Address - Country:US
Practice Address - Phone:732-506-6868
Practice Address - Fax:732-506-6879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04807200207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ004058Medicare ID - Type Unspecified
NJD19533Medicare UPIN