Provider Demographics
NPI:1699722736
Name:MATATOV, VALERIY A (MD)
Entity type:Individual
Prefix:
First Name:VALERIY
Middle Name:A
Last Name:MATATOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7206 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2617
Mailing Address - Country:US
Mailing Address - Phone:718-745-1200
Mailing Address - Fax:718-836-5128
Practice Address - Street 1:7206 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2617
Practice Address - Country:US
Practice Address - Phone:718-745-1200
Practice Address - Fax:718-836-5128
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222002-1207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02528641Medicaid
NY7V6751Medicare PIN
NY02528641Medicaid