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General NPI Number Information
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NPI Number | 1932867397
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Entity Type | Individual
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Provider Name | KATY MABUNAY MATILLA CRNA
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Gender | Female
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Dates
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Enumeration Date | 12/02/2021
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Last Update Date | 06/11/2026
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Provider Practice Location Address
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Address Line | 140 PARK AVE
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City | FLORHAM PARK
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State | NJ
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Zip | 07932-1049
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Country | US
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Telephone | 973-718-5800
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Fax | 973-829-4332
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Provider Business Mailing Address
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Address Line | 1 DIAMOND HILL RD
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City | BERKELEY HEIGHTS
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State | NJ
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Zip | 07922-2104
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Country | US
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Telephone | 908-273-4300
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 26NJ14944800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 95001614
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 881444
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APRN11045940
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License Number State | FL
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