Healthcare Provider Details

I. General information

NPI: 1093488520
Provider Name (Legal Business Name): MATTHEW SIDLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 BELLEVILLE AVE
BLOOMFIELD NJ
07003-3652
US

IV. Provider business mailing address

234 DAVEY ST APT A
BLOOMFIELD NJ
07003-6163
US

V. Phone/Fax

Practice location:
  • Phone: 973-532-2132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: