Provider Demographics
NPI:1205079209
Name:MATHEW, GLENDA L (NP-C)
Entity type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:L
Last Name:MATHEW
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MRS
Other - First Name:GLENDA
Other - Middle Name:L
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:629 CRANBURY RD FL 2
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4096
Mailing Address - Country:US
Mailing Address - Phone:732-390-7750
Mailing Address - Fax:732-390-7725
Practice Address - Street 1:53 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAYREVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08872-1559
Practice Address - Country:US
Practice Address - Phone:732-254-6200
Practice Address - Fax:732-254-7803
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26N300175400363L00000X
NJ26NJ00175400363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0371084Medicaid
NJ12483977OtherCAQH ID