Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 25MA09043900 | NJ |
NPI | 1013275791 |
---|---|
Provider Name | Julie Mathew |
First Address | Red Bank, NJ 07701 |
Second Address | New Brunswick, NJ 08901-1928 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2012 |
Last Update Date | 09/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0304921 | (05) | NJ |