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General NPI Number Information
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NPI Number | 1487896148
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Entity Type | Individual
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Provider Name | MATTHEW LOBOSCO M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 10/30/2020
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Provider Practice Location Address
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Address Line | 515 VALLEY ST STE 203
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-4300
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Country | US
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Telephone | 908-663-2929
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Fax | 908-219-6213
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Provider Business Mailing Address
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Address Line | 515 VALLEY ST STE 203
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-4300
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Country | US
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Telephone | 908-663-2929
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Fax | 908-219-6213
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 271894
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License Number State | NY
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