Individual
MATTHEW THOMAS VANDEVENTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APN, CRNA
Contact information
Practice address
125 PATERSON ST, NEW BRUNSWICK, NJ 08901-1962
(732) 828-3000
Mailing address
125 PATERSON ST, NEW BRUNSWICK, NJ 08901-1962
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
209348
SC
163W00000X
Registered Nurse
26NR17755100
NJ
367500000X
Certified Registered Nurse Anesthetist
Primary
26NJ00552900
NJ
Other
Enumeration date
03/03/2015
Last updated
10/27/2020
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