Healthcare Provider Details

I. General information

NPI: 1508720723
Provider Name (Legal Business Name): IRINA MATATOVA, NP IN FAMILY HEALTH, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 MONTANA PL
BROOKLYN NY
11234-6912
US

IV. Provider business mailing address

17 MONTANA PL
BROOKLYN NY
11234-6912
US

V. Phone/Fax

Practice location:
  • Phone: 917-485-3482
  • Fax:
Mailing address:
  • Phone: 646-873-6822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. IRINA MATATOVA
Title or Position: PRESIDENT
Credential: FNP
Phone: 646-873-6822