Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 2267500 | NJ |
NPI | 1104020999 |
---|---|
Provider Name | Dr. Manjiri Bhate Mathur |
First Address | Hillsborough, NJ 08844-4525 |
Second Address | Hillsborough, NJ 08844-4525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 10/01/2012 |