MEDICARE: DR. JEFFREY A MATTES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	40597	NJ

General Provider Information

NPI Number	:	1104823806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY A MATTES MD

Provider Business Mailing Address
First Line	:	601 EWING ST
Second Line	:	STE A-12
City	:	PRINCETON
State	:	NJ
Zip	:	08540-2757
Country	:	US
Telephone Number	:	609-921-9299
Fax Number	:	609-921-1332

Provider Business Practice Location Address
First Line	:	601 EWING ST
Second Line	:	STE A-12
City	:	PRINCETON
State	:	NJ
Zip	:	08540-2757
Country	:	US
Telephone Number	:	609-921-9299
Fax Number	:	609-921-1332

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	02/15/2011

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