Provider Demographics
NPI:1376538835
Name:MATTHAI, JANIS T (CRNP)
Entity Type:Individual
Prefix:MS
First Name:JANIS
Middle Name:T
Last Name:MATTHAI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JANIS
Other - Middle Name:S
Other - Last Name:TOWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 E. NEW YORK AVENUE
Mailing Address - Street 2:PENN CARDIOLOGY AT SHORE MEMORIAL
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244
Mailing Address - Country:US
Mailing Address - Phone:856-216-0300
Mailing Address - Fax:
Practice Address - Street 1:1 E. NEW YORK AVENUE
Practice Address - Street 2:PENN CARDIOLOGY AT SHORE MEMORIAL
Practice Address - City:SOMERS POINT,
Practice Address - State:NJ
Practice Address - Zip Code:08244
Practice Address - Country:US
Practice Address - Phone:856-216-0300
Practice Address - Fax:609-653-3960
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN072123363LF0000X
NJ26NN07212300363LF0000X
PAVP004288B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ057752PKMMedicare ID - Type Unspecified
NJ6808204Medicare ID - Type Unspecified
NJP58423Medicare UPIN