Provider Demographics
NPI:1235953522
Name:SCOTT, MATTHIAS A (LMT, MMP, COMT)
Entity type:Individual
Prefix:
First Name:MATTHIAS
Middle Name:A
Last Name:SCOTT
Suffix:
Gender:M
Credentials:LMT, MMP, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LLOYD CT APT 2B
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2367
Mailing Address - Country:US
Mailing Address - Phone:973-931-5803
Mailing Address - Fax:
Practice Address - Street 1:70 OUTWATER LN
Practice Address - Street 2:2ND FL
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-3854
Practice Address - Country:US
Practice Address - Phone:844-371-1125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00839000225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist