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General NPI Number Information
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NPI Number | 1003017294
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Entity Type | Individual
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Provider Name | SAJI MATHEW O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 205 QUAKER BRIDGE MALL
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-1900
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Country | US
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Telephone | 609-799-0809
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Fax |
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Provider Business Mailing Address
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Address Line | 911 SPRING VIEW DR
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City | SOUTHAMPTON
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State | PA
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Zip | 18966-4308
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Country | US
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Telephone | 215-275-4073
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 27OA00563600
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License Number State | NJ
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