Basic Information
| Provider Information | |||||||||
| NPI: | 1346240660 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATTEI | ||||||||
| FirstName: | CRUZ | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MATTEI | ||||||||
| OtherFirstName: | C. | ||||||||
| OtherMiddleName: | ANTONIA | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1100 WESCOTT DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | FLEMINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087886535 | ||||||||
| FaxNumber: | 9087886536 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 WESCOTT DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | FLEMINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088224600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087886535 | ||||||||
| FaxNumber: | 9087886536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MA60064 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7025505 | 05 | NJ | MEDICAID |