Provider Demographics
NPI:1558759191
Name:MATHEW, SIJU (CRNA)
Entity Type:Individual
Prefix:
First Name:SIJU
Middle Name:
Last Name:MATHEW
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 ROUTE 59
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4927
Mailing Address - Country:US
Mailing Address - Phone:845-357-5775
Mailing Address - Fax:845-357-5777
Practice Address - Street 1:1 BAY AVE
Practice Address - Street 2:ANESTHESIA OFFICE
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4837
Practice Address - Country:US
Practice Address - Phone:973-429-6219
Practice Address - Fax:845-547-0740
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2015-05-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NR15938100163W00000X
NJ26NJ00554700367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse