Provider Demographics
NPI:1710158365
Name:MATTIE, JAMES KENNETH JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KENNETH
Last Name:MATTIE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:92 LAKESIDE TRL
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2894
Mailing Address - Country:US
Mailing Address - Phone:201-602-9209
Mailing Address - Fax:
Practice Address - Street 1:3799 ROUTE 46 STE 301
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1060
Practice Address - Country:US
Practice Address - Phone:973-335-1122
Practice Address - Fax:973-335-1446
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA08955000207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program