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General NPI Number Information
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NPI Number | 1578148185
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Entity Type | Organization
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Legal Business Name | MARINA MATATOVA DO PC
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Dates
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Enumeration Date | 03/15/2021
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Last Update Date | 03/15/2021
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Provider Practice Location Address
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Address Line | 391 STANHOPE ST
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City | BROOKLYN
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State | NY
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Zip | 11237-4404
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Country | US
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Telephone | 718-366-1747
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Fax | 718-606-8966
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Provider Business Mailing Address
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Address Line | 4037 74TH ST
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City | ELMHURST
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State | NY
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Zip | 11373-5603
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Country | US
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Telephone | 718-651-7000
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Fax | 718-606-8966
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | WENDY SANCHEZ
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Credential |
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Telephone | 347-642-9802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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