Healthcare Provider Details

I. General information

NPI: 1861358020
Provider Name (Legal Business Name): YAKHIEL MATATOV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2026
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 WHITESTONE EXPY
FLUSHING NY
11354-1964
US

IV. Provider business mailing address

14429 71ST RD FL 2
FLUSHING NY
11367-2001
US

V. Phone/Fax

Practice location:
  • Phone: 929-264-3354
  • Fax:
Mailing address:
  • Phone: 929-264-3354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number826763
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: