Healthcare Provider Details

I. General information

NPI: 1548072036
Provider Name (Legal Business Name): RM NP IN ADULT HEALTH P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 QUEENS BLVD STE 200
WOODSIDE NY
11377-5769
US

IV. Provider business mailing address

6535 QUEENS BLVD STE 200
WOODSIDE NY
11377-5769
US

V. Phone/Fax

Practice location:
  • Phone: 718-426-4242
  • Fax:
Mailing address:
  • Phone: 718-426-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RIGINA MATATOVA
Title or Position: OWNER
Credential: NP
Phone: 917-361-9333