Provider Demographics
NPI:1215240940
Name:MATT HOSSEINI DPM PHD INC
Entity type:Organization
Organization Name:MATT HOSSEINI DPM PHD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSSEINI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-825-7331
Mailing Address - Street 1:2728 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-9638
Mailing Address - Country:US
Mailing Address - Phone:856-825-7331
Mailing Address - Fax:856-825-7512
Practice Address - Street 1:2728 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-9638
Practice Address - Country:US
Practice Address - Phone:856-825-7331
Practice Address - Fax:856-825-7512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00252900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7910509Medicaid
NJUP75130Medicare UPIN