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General NPI Number Information
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NPI Number | 1477573657
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Entity Type | Individual
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Provider Name | OMANA REJI MATHEW M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 167 S WASHINGTON AVE
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City | BERGENFIELD
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State | NJ
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Zip | 07621-2903
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Country | US
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Telephone | 201-384-8510
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Fax |
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Provider Business Mailing Address
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Address Line | 167 SOUTH WASHINGTON AVE
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City | BERGENFIELD
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State | NJ
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Zip | 07621
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Country | US
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Telephone | 201-384-8510
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MA061019
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License Number State | NJ
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