Provider Demographics
NPI:1316501430
Name:MATHEW, NEETHA (DO)
Entity type:Individual
Prefix:
First Name:NEETHA
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 CARNOT AVE
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-7939
Mailing Address - Country:US
Mailing Address - Phone:201-925-9796
Mailing Address - Fax:
Practice Address - Street 1:767 NORTHFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1194
Practice Address - Country:US
Practice Address - Phone:973-992-9022
Practice Address - Fax:073-992-9024
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11307600207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology