Provider Demographics
NPI:1952782096
Name:MATHEW, DEEPA (DO)
Entity type:Individual
Prefix:
First Name:DEEPA
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WYCKOFF RD STE 4200
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-0199
Mailing Address - Country:US
Mailing Address - Phone:732-935-7143
Mailing Address - Fax:732-935-7245
Practice Address - Street 1:200 WYCKOFF RD STE 4200
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-0199
Practice Address - Country:US
Practice Address - Phone:732-935-7143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2943542080P0205X
PAOS0213572080P0205X
NJ25MB122592002080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology