Provider Demographics
NPI:1528145836
Name:MASTROPIETRO, TRICIA (BA DC)
Entity type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:
Last Name:MASTROPIETRO
Suffix:
Gender:F
Credentials:BA DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 RARITAN RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1330
Mailing Address - Country:US
Mailing Address - Phone:732-388-3828
Mailing Address - Fax:732-388-3829
Practice Address - Street 1:1114 RARITAN RD
Practice Address - Street 2:SUITE 4
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1330
Practice Address - Country:US
Practice Address - Phone:732-388-3828
Practice Address - Fax:732-388-3829
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00600800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00192623OtherRAILROAD MEDICARE #
NJ066781TLKOtherMEDICARE PROVIDER PIN #
NJDC8296OtherRAILROAD MEDICARE GROUP #
NJP2901780OtherOXFORD PROVIDER #
NJ3698573OtherAETNA PROV #
NJ3698573OtherAETNA PROV #