Individual provider Active NPI

Jesvin Mathew, FNP

  • Family Nurse Practitioner
  • Mahwah, NJ
National Provider Identifier
1043600117
Registry record updated Sep 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
345857 Issued in NY
Practice address
10 Franklin Tpke
Mahwah, NJ 07430-1304
Phone
(201) 529-0033
NPI assigned
Jan 28, 2015
Last updated
Sep 28, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 345857 NY Primary
Family Nurse Practitioner 363LF0000X 26NJ00549800 NJ

Addresses

Primary practice location

10 Franklin Tpke
Mahwah, NJ 07430-1304

Mailing address

20 Grand St FL 3
Warwick, NY 10990-1035
Phone (845) 353-5600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150625001013 NJ Practitioner - Nurse Practitioner 0042521452 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Rutgers New Jersey Medical School, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Excelcare Medical Associates PAGroup PAC ID 4284647868, 200 clinicians

Practice addresses (Care Compare)

718 Teaneck Rd
Teaneck, NJ 07666-4245
Phone (201) 833-3909

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
345857NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Excelcare Medical Associates, PA CurrentSince Mar 1, 2021 Accepting new patients

Locations

3 University Plz
Ste 205
Hackensack, NJ 07601

680 Kinderkamack Rd
Ste 207
Oradell, NJ 07649
Phone (201) 487-7246

718 Teaneck Rd
Teaneck, NJ 07666
Phone (201) 833-3232

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1422403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601251200000",
    "number": "1043600117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 GRAND ST FL 3",
            "city": "WARWICK",
            "state": "NY",
            "postal_code": "109901035",
            "telephone_number": "845-353-5600",
            "fax_number": "845-987-5979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 FRANKLIN TPKE",
            "city": "MAHWAH",
            "state": "NJ",
            "postal_code": "074301304",
            "telephone_number": "201-529-0033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEW",
        "first_name": "JESVIN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-28",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "345857",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ00549800",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mahwah, NJ

Sources for this page

Verify at the official NPI Registry.