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General NPI Number Information
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NPI Number | 1588076806
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Entity Type | Individual
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Provider Name | MATVEY YAGUDAYEV DPM
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Gender | Male
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Dates
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Enumeration Date | 05/21/2014
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Last Update Date | 05/08/2017
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Provider Practice Location Address
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Address Line | 9920 4TH AVE STE 109
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City | BROOKLYN
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State | NY
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Zip | 11209-8379
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Country | US
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Telephone | 646-339-4208
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Fax |
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Provider Business Mailing Address
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Address Line | 6625 103RD ST APT 6F
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City | FOREST HILLS
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State | NY
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Zip | 11375-2020
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Country | US
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Telephone | 646-339-4208
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | N006808
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License Number State | NY
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