Provider Demographics
NPI:1174848261
Name:CLUDERAY, MATTHEW A (APN)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:A
Last Name:CLUDERAY
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 ROUTE 70 E BLDG A
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2341
Mailing Address - Country:US
Mailing Address - Phone:856-797-4771
Mailing Address - Fax:856-797-4785
Practice Address - Street 1:765 ROUTE 70 E BLDG A
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2341
Practice Address - Country:US
Practice Address - Phone:856-797-4771
Practice Address - Fax:856-797-4785
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NJ26NJ15177900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator