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General NPI Number Information
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NPI Number | 1215079249
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Entity Type | Organization
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Legal Business Name | CHRIS MATTHEOU MD PA
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 09/05/2012
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Provider Practice Location Address
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Address Line | 208 PASSAIC AVENUE
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City | PASSAIC
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State | NJ
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Zip | 07055
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Country | US
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Telephone | 973-779-0012
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Fax | 973-916-1565
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Provider Business Mailing Address
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Address Line | 208 PASSAIC AVENUE
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City | PASSAIC
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State | NJ
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Zip | 07055
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Country | US
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Telephone | 973-779-0012
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Fax | 973-916-1565
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHRIS MATTHEOU
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Credential | MD, PA
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Telephone | 973-779-0012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 25MA02377200
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License Number State | NJ
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