Provider Demographics
NPI:1386109593
Name:MATRIC HEALTH LLC
Entity type:Organization
Organization Name:MATRIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOUBACAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DIALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-236-5719
Mailing Address - Street 1:1474 NEW YORK AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-1649
Mailing Address - Country:US
Mailing Address - Phone:929-236-5719
Mailing Address - Fax:
Practice Address - Street 1:1474 NEW YORK AVE FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-1649
Practice Address - Country:US
Practice Address - Phone:929-236-5719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies