Healthcare Provider Details

I. General information

NPI: 1245916949
Provider Name (Legal Business Name): MAURA MI MATHEWS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 DODD ST
WEEHAWKEN NJ
07086-5616
US

IV. Provider business mailing address

122 DODD ST
WEEHAWKEN NJ
07086-5616
US

V. Phone/Fax

Practice location:
  • Phone: 917-627-6307
  • Fax:
Mailing address:
  • Phone: 917-627-6307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF311281-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ14926500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: