Basic Information
| Provider Information | |||||||||
| NPI: | 1497872824 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHETTINO | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1006 MANTUA PIKE | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080971253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568458600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 409 ROUTE 70 EAST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080342413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564274336 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 11/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 25MA08796300 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207RS0010X | MD439645 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine |
No ID Information.