Provider Demographics
NPI:1255591921
Name:MATHEW, MINI ANN (DO)
Entity type:Individual
Prefix:DR
First Name:MINI
Middle Name:ANN
Last Name:MATHEW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 STATE ROUTE 33
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6104
Mailing Address - Country:US
Mailing Address - Phone:732-897-3980
Mailing Address - Fax:732-897-3982
Practice Address - Street 1:2240 RTE 33 STE B
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-6104
Practice Address - Country:US
Practice Address - Phone:732-897-3980
Practice Address - Fax:732-897-3982
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08678200207RE0101X, 207R00000X
IL036124643207R00000X
PAOS014797207R00000X
TXN8320207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0220621Medicaid
NJ0220621Medicaid