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General NPI Number Information
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NPI Number | 1124512843
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Entity Type | Individual
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Provider Name | NIMMY MATHEW
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Gender | Female
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Dates
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Enumeration Date | 06/16/2018
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 100 E CARROLL ST
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City | SALISBURY
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State | MD
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Zip | 21801-5422
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Country | US
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Telephone | 908-583-3551
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Fax |
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Provider Business Mailing Address
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Address Line | 171 E LINCOLN AVE
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City | ROSELLE PARK
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State | NJ
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Zip | 07204-1705
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Country | US
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Telephone |
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | D0091078
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | MT215065
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License Number State | PA
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