Healthcare Provider Details

I. General information

NPI: 1598394447
Provider Name (Legal Business Name): MELVIN MATHEW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3196 JOHN F KENNEDY BLVD
UNION CITY NJ
07087
US

IV. Provider business mailing address

3196 JOHN F KENNEDY BLVD
UNION CITY NJ
07087
US

V. Phone/Fax

Practice location:
  • Phone: 551-240-3500
  • Fax: 551-244-1552
Mailing address:
  • Phone: 551-240-3500
  • Fax: 551-244-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA193117
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA12001300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: