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General NPI Number Information
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NPI Number | 1548072036
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Entity Type | Organization
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Legal Business Name | RM NP IN ADULT HEALTH P C
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 6535 QUEENS BLVD STE 200
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City | WOODSIDE
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State | NY
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Zip | 11377-5769
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Country | US
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Telephone | 718-426-4242
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Fax |
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Provider Business Mailing Address
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Address Line | 6535 QUEENS BLVD STE 200
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City | WOODSIDE
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State | NY
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Zip | 11377-5769
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Country | US
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Telephone | 718-426-4242
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RIGINA MATATOVA
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Credential | NP
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Telephone | 917-361-9333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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