Provider Demographics
NPI:1104292648
Name:MATHENY SCHOOL AND HOSPITAL
Entity type:Organization
Organization Name:MATHENY SCHOOL AND HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPROTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD JD
Authorized Official - Phone:908-234-0011
Mailing Address - Street 1:65 HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:PEAPACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07977-0339
Mailing Address - Country:US
Mailing Address - Phone:908-234-0011
Mailing Address - Fax:908-234-9367
Practice Address - Street 1:65 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:PEAPACK
Practice Address - State:NJ
Practice Address - Zip Code:07977-0339
Practice Address - Country:US
Practice Address - Phone:908-234-0011
Practice Address - Fax:908-234-9367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4143001Medicaid
NJ4143001Medicaid
NJ312015Medicare Oscar/Certification