Provider Demographics
NPI:1558620393
Name:MUTHUKA, ESHBAN (APN)
Entity Type:Individual
Prefix:
First Name:ESHBAN
Middle Name:
Last Name:MUTHUKA
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 PARK ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-2534
Mailing Address - Country:US
Mailing Address - Phone:908-672-2472
Mailing Address - Fax:
Practice Address - Street 1:170 PARK ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-2534
Practice Address - Country:US
Practice Address - Phone:908-672-2472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00373700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner