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1205079209 NPI number — GLENDA L. MATHEW NP

NPI Number: 1205079209
Health Care Provider/Practitioner: GLENDA L. MATHEW NP

Information about “1205079209” NPI (GLENDA L. MATHEW NP) exists in 1205079209 in HTML format HTML  |  1205079209 in plain Text format TXT  |  1205079209 in PDF (Portable Document Format) PDF  |  1205079209 in an XML format XML  formats.

NPI Number : 1205079209 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205079209",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MATHEW",
    "FirstName": "GLENDA",
    "MiddleName": "L.",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MATHEW",
    "OtherFirstName": "GLENDA",
    "OtherMiddleName": "L",
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": "NP-C",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "629 CRANBURY RD FL 2",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EAST BRUNSWICK",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "08816-4096",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "732-390-7750",
    "MailingAddressFaxNumber": "732-390-7725",
    "FirstLinePracticeLocationAddress": "149 MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SOUTH RIVER",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "08882-1232",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "732-238-6440",
    "PracticeLocationAddressFaxNumber": "732-651-1431",
    "EnumerationDate": "04/07/2009",
    "LastUpdateDate": "08/21/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LA2200X",
          "TaxonomyName": "Adult Health Nurse Practitioner",
          "LicenseNumber": "26NJ00175400",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "26N300175400",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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