Provider Demographics
NPI:1730231150
Name:WESTMONT MEDICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:WESTMONT MEDICAL ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:P
Authorized Official - Last Name:OLIVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-854-0300
Mailing Address - Street 1:201 HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:WESMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2860
Mailing Address - Country:US
Mailing Address - Phone:856-854-0300
Mailing Address - Fax:856-854-4107
Practice Address - Street 1:201 HADDON AVE
Practice Address - Street 2:
Practice Address - City:WESMONT
Practice Address - State:NJ
Practice Address - Zip Code:08108-2860
Practice Address - Country:US
Practice Address - Phone:856-854-0300
Practice Address - Fax:856-854-4107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04753100207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ501046Medicare ID - Type Unspecified