Provider Demographics
NPI:1972515005
Name:JAMES A. DIMATTIA, D.C., P.C.
Entity type:Organization
Organization Name:JAMES A. DIMATTIA, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIMATTIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-883-9262
Mailing Address - Street 1:1200 LAWRENCEVILLE RD
Mailing Address - Street 2:2-B
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-3551
Mailing Address - Country:US
Mailing Address - Phone:609-883-9262
Mailing Address - Fax:609-883-9263
Practice Address - Street 1:1200 LAWRENCEVILLE RD
Practice Address - Street 2:2-B
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-3551
Practice Address - Country:US
Practice Address - Phone:609-883-9262
Practice Address - Fax:609-883-9263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00587600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2144439000OtherIND. BLUE CROSS HMO
NJ3309992OtherAETNA
NJP3308235OtherOXFORD
NJ2144439000OtherIND. BLUE CROSS HMO
NJ=========OtherUNITED HELATHCARE
NJ3309992OtherAETNA
NJ080789Medicare ID - Type UnspecifiedMEDICARE