Individual
DARA MATSEOANE-PETERSSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5141 BROADWAY, NEW YORK, NY 10034-1159
(212) 305-4098
(212) 305-4098
Mailing address
622 W 168TH ST, NEW YORK, NY 10032-3720
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
221332-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02177824
—
NY
Enumeration date
07/15/2006
Last updated
03/30/2023
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