| Doctor Name: | JESVIN MATHEW |
| NPI Number: | 1043600117 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APN BC |
| License Number: | 26NJ00549800 |
| Business Practice Address: | 10 Franklin Tpke Mahwah, NJ - 074301304 |
| Business Phone Number: | 2015290033 |
| Business Fax Number: | |
| Mailing Address: | 117 Barclay Drive, NUTLEY |
| State: | NJ |
| Postal Code: | 07110 |
| Phone Number: | 4152727311 |
| Fax Number: | |
| NPI Enumeration Date: | 01/28/2015 |
| NPI Last Update Date: | 04/22/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 26NJ00549800 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |