Healthcare Provider Details

I. General information

NPI: 1679376248
Provider Name (Legal Business Name): MR. MATTHEW MAGUIRE III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 ROCKRIMMON BLVD
BARNEGAT NJ
08005-1728
US

IV. Provider business mailing address

115 ROCKRIMMON BLVD
BARNEGAT NJ
08005-1728
US

V. Phone/Fax

Practice location:
  • Phone: 732-320-1921
  • Fax:
Mailing address:
  • Phone: 732-320-1921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15650700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR23774100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: