Provider Demographics
NPI:1801261060
Name:MATOS, ELIANET J (NP)
Entity type:Individual
Prefix:
First Name:ELIANET
Middle Name:J
Last Name:MATOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 W 181ST ST # B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-5102
Mailing Address - Country:US
Mailing Address - Phone:347-898-2615
Mailing Address - Fax:347-808-2716
Practice Address - Street 1:517 W 181ST ST # B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-5102
Practice Address - Country:US
Practice Address - Phone:347-808-2615
Practice Address - Fax:347-808-2716
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY706420163W00000X
NYF35116901363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse