Provider Demographics
NPI:1356736862
Name:MATHEW, JUSTIN DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:DANIEL
Last Name:MATHEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 BERGEN ST
Mailing Address - Street 2:DEPARTMENT OF MEDICINE/OFFICE OF EDUCATION
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2496
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3400 BAINBRIDGE AVE FL 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2404
Practice Address - Country:US
Practice Address - Phone:866-633-8255
Practice Address - Fax:718-920-5202
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY311137207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism