Healthcare Provider Details

I. General information

NPI: 1366196636
Provider Name (Legal Business Name): CHRISTOPHER J MATTINA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 06/14/2023
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RIVER RD STE 113
EDGEWATER NJ
07020-1149
US

IV. Provider business mailing address

725 RIVER RD STE 113
EDGEWATER NJ
07020-1149
US

V. Phone/Fax

Practice location:
  • Phone: 201-861-6800
  • Fax: 201-962-9068
Mailing address:
  • Phone: 201-861-6800
  • Fax: 201-962-9068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00789500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: