Provider Demographics
NPI:1003033150
Name:MATHEW, SUNAINA ELIZABETH
Entity Type:Individual
Prefix:
First Name:SUNAINA
Middle Name:ELIZABETH
Last Name:MATHEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 RIVER RD
Mailing Address - Street 2:#B-25
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1335
Mailing Address - Country:US
Mailing Address - Phone:201-969-2582
Mailing Address - Fax:
Practice Address - Street 1:219 ESSEX ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3215
Practice Address - Country:US
Practice Address - Phone:201-488-7224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02924300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist