Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | F309536-01 | NY |
NPI | 1043831530 |
---|---|
Provider Name | Rigina Matatova |
First Address | Rego Park, NY 11374-2667 |
Second Address | Rego Park, NY 11374-2667 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2020 |
Last Update Date | 06/05/2020 |