Provider Demographics
NPI:1881842235
Name:MATYAS, MARY (APN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MATYAS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:FARRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:150 NEW PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-1409
Mailing Address - Country:US
Mailing Address - Phone:908-233-3720
Mailing Address - Fax:908-301-5456
Practice Address - Street 1:6106 BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-9701
Practice Address - Country:US
Practice Address - Phone:609-645-7779
Practice Address - Fax:908-301-5456
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN75099363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics