Provider Demographics
NPI:1023633435
Name:VIAJE, MABRIGIDA S (APN)
Entity type:Individual
Prefix:
First Name:MABRIGIDA
Middle Name:S
Last Name:VIAJE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 DONALD CIR
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-9521
Mailing Address - Country:US
Mailing Address - Phone:732-687-0204
Mailing Address - Fax:
Practice Address - Street 1:1440 PENNINGTON RD
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-2669
Practice Address - Country:US
Practice Address - Phone:609-890-1050
Practice Address - Fax:609-890-0950
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00826200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner