Provider Demographics
NPI:1205079209
Name:MATHEW, GLENDA L (NP)
Entity type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:L
Last Name:MATHEW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:GLENDA
Other - Middle Name:L
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:629 CRANBURY RD FL 2
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4096
Mailing Address - Country:US
Mailing Address - Phone:732-390-7750
Mailing Address - Fax:732-390-7725
Practice Address - Street 1:149 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08882-1232
Practice Address - Country:US
Practice Address - Phone:732-238-6440
Practice Address - Fax:732-651-1431
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00175400363LA2200X
NJ26N300175400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0371084Medicaid
NJ12483977OtherCAQH ID