Healthcare Provider Details

I. General information

NPI: 1356195655
Provider Name (Legal Business Name): MOBY BIJU MATHEW AGACNP-BC, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ROBERT WOOD JOHNSON PL
NEW BRUNSWICK NJ
08901-1928
US

IV. Provider business mailing address

1 ROBERT WOOD JOHNSON PL
NEW BRUNSWICK NJ
08901-1928
US

V. Phone/Fax

Practice location:
  • Phone: 732-828-3000
  • Fax:
Mailing address:
  • Phone: 732-235-7733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ15049000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number26NJ15049000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ15049000
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ15049000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: