Healthcare Provider Details

I. General information

NPI: 1255591921
Provider Name (Legal Business Name): MINI ANN MATHEW D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 RTE 33 STE B
NEPTUNE NJ
07753-6104
US

IV. Provider business mailing address

2240 STATE ROUTE 33
NEPTUNE NJ
07753-6104
US

V. Phone/Fax

Practice location:
  • Phone: 732-897-3980
  • Fax: 732-897-3982
Mailing address:
  • Phone: 732-897-3980
  • Fax: 732-897-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25MB08678200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: