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Individual

MATILDA MIRANDA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
215 UNION AVE, BRIDGEWATER, NJ 08807-3063
(908) 722-2900
(908) 722-1856
Mailing address
PO BOX 22581, NEW YORK, NY 10087-2581
(610) 482-4795
(856) 528-3117

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
25MA07737000
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0062235
NJ
01
25MA07737000
NJ MEDICAL LICENSE
NJ
01
D08538800
CONTROLLED DANGERAOUS SUB
NJ
Enumeration date
06/06/2006
Last updated
03/07/2023
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