Provider Demographics
NPI:1851046296
Name:MATHEW, SUSANNA MOANA (CNM)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:MOANA
Last Name:MATHEW
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HILLVIEW TER
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6521
Mailing Address - Country:US
Mailing Address - Phone:973-519-0283
Mailing Address - Fax:
Practice Address - Street 1:250 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-2237
Practice Address - Country:US
Practice Address - Phone:973-264-4307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00077501367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife