Healthcare Provider Details

I. General information

NPI: 1730042409
Provider Name (Legal Business Name): MRS. VANESSA MATHURIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA EZEMADU

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 GEORGE ST STE 4
NEW BRUNSWICK NJ
08901-4080
US

IV. Provider business mailing address

335 GEORGE ST STE 4
NEW BRUNSWICK NJ
08901-4080
US

V. Phone/Fax

Practice location:
  • Phone: 848-305-7071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: