Provider Demographics
NPI:1588076806
Name:YAGUDAYEV, MATVEY (DPM)
Entity type:Individual
Prefix:DR
First Name:MATVEY
Middle Name:
Last Name:YAGUDAYEV
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 103RD ST APT 6F
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2020
Mailing Address - Country:US
Mailing Address - Phone:646-339-4208
Mailing Address - Fax:
Practice Address - Street 1:9920 4TH AVE STE 109
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-8379
Practice Address - Country:US
Practice Address - Phone:646-339-4208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006808213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery