Provider Demographics
NPI:1730142084
Name:MATHENY SCHOOL AND HOSPITAL
Entity Type:Organization
Organization Name:MATHENY SCHOOL AND HOSPITAL
Other - Org Name:MATHENY MEDICAL AND EDUCATIONAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-234-0011
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:PEAPACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07977
Mailing Address - Country:US
Mailing Address - Phone:908-234-0011
Mailing Address - Fax:908-234-9496
Practice Address - Street 1:1467 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:PEAPACK
Practice Address - State:NJ
Practice Address - Zip Code:07977
Practice Address - Country:US
Practice Address - Phone:908-234-0011
Practice Address - Fax:908-234-9496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ21801122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8620709Medicaid
NJ312014Medicare ID - Type Unspecified