Healthcare Provider Details

I. General information

NPI: 1336534858
Provider Name (Legal Business Name): MATTHEW MASON COUNIHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 FROM RD STE 420
PARAMUS NJ
07652-3551
US

IV. Provider business mailing address

650 FROM RD STE 420
PARAMUS NJ
07652-3551
US

V. Phone/Fax

Practice location:
  • Phone: 215-534-4837
  • Fax:
Mailing address:
  • Phone: 215-534-4837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number25MA11864300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: