Active NPI
Omana Reji Mathew, M.D.
- Pediatrics Physician
- Bergenfield, NJ
National Provider Identifier
1477573657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MA061019
- Practice address
- 167 S Washington Ave
Bergenfield, NJ 07621-2903 - Phone
- (201) 384-8510
- NPI assigned
- Jul 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MA061019 | NJ | Primary |
Addresses
Primary practice location
167 S Washington Ave
Bergenfield, NJ 07621-2903
Mailing address
167 South Washington Ave
Bergenfield, NJ 07621
Phone (201) 384-8510
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA061019 | NJ | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bergen Pediatric Center,P.C | Pediatrics | Past | Accepting new patients |
| Practice Associates,Inc | Pediatrics | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- Bergenfield, NJ
- NPI 1750302683
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1477573657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "167 SOUTH WASHINGTON AVE",
"city": "BERGENFIELD",
"state": "NJ",
"postal_code": "07621",
"telephone_number": "201-384-8510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "167 S WASHINGTON AVE",
"city": "BERGENFIELD",
"state": "NJ",
"postal_code": "076212903",
"telephone_number": "201-384-8510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHEW",
"first_name": "OMANA",
"middle_name": "REJI",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "MA061019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bergenfield, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.