Provider Demographics
NPI:1710525506
Name:MATHEN, REENA VARGHESE (APN)
Entity Type:Individual
Prefix:MRS
First Name:REENA
Middle Name:VARGHESE
Last Name:MATHEN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-2700
Mailing Address - Country:US
Mailing Address - Phone:201-873-7475
Mailing Address - Fax:
Practice Address - Street 1:8 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-2536
Practice Address - Country:US
Practice Address - Phone:201-474-5189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00997800363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology