Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 38MC00137000 | NJ |
NPI | 1326075987 |
---|---|
Provider Name | Dr. Michael Nicholas Mastoris |
First Address | Hightstown, NJ 08520-3224 |
Second Address | Hightstown, NJ 08520-3224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
44592 | (02) | NJ |
6643108 | (05) | NJ |