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General NPI Number Information
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NPI Number | 1508978917
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Entity Type | Individual
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Provider Name | ALAN EARL MATONTI LCADC
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 30 BRIARWOOD AVE 51 MEMORIAL PARKWAY
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City | ATLANTIC HIGHLANDS
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State | NJ
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Zip | 07716-2014
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Country | US
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Telephone | 732-291-7997
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Fax |
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Provider Business Mailing Address
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Address Line | 30 BRIARWOOD AVE
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City | ATLANTIC HIGHLANDS
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State | NJ
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Zip | 07716-2014
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Country | US
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Telephone | 732-291-7997
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Fax |
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 37LC00037100
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License Number State | NJ
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