Provider Demographics
NPI:1669524146
Name:SHOHEN, MATTHEW I (PT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:I
Last Name:SHOHEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 PONDEROSA TRL
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3229
Mailing Address - Country:US
Mailing Address - Phone:201-452-8703
Mailing Address - Fax:
Practice Address - Street 1:13 PONDEROSA TRL
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3229
Practice Address - Country:US
Practice Address - Phone:201-452-8703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA014178002251S0007X
NJQA01417800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9429OtherMEDICARE GROUP PTAN
SCQ34421OtherMEDICARE PTAN