Individual
DEVICA MATUKNATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7901 BROADWAY, ELMHURST, NY 11373-1329
(718) 334-4000
Mailing address
11124 121ST ST, SOUTH OZONE PARK, NY 11420-1341
(191) 794-0632
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
351557
NY
Other
Enumeration date
06/21/2023
Last updated
06/21/2023
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