Shane Anthony Mata, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA01754500 Issued in NJ

Practice address

600 S Livingston Ave
Livingston, NJ 07039-5419

Phone

(973) 992-0733

Fax

(973) 992-0734

NPI assigned

Jan 10, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1515542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521590400000",
    "number": "1134636202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 S LIVINGSTON AVE STE 210",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070395415",
            "telephone_number": "973-992-0733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S LIVINGSTON AVE",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070395419",
            "telephone_number": "973-992-0733",
            "fax_number": "973-992-0734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATA",
        "first_name": "SHANE",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-01-10",
        "last_updated": "2018-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01754500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Rose Martinez
• Melissa Martoccia
• Margaret Masiello, R.D.
• Joshua Mathew Massler, PSY.D., M.A.
• Lily Mastronardi
• Nadeen Matari
• Farah Mateo, RN
• Jacob J Mathew, M.D., PHARM.D.
• Sherry Mathew, PA-C
• Tobin Punnoose Mathew, DNP

• Physical Therapist in Livingston, NJ
• Providers in Livingston, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.