Individual
LEV Y MATATOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CFO,BOCO,COTA
Contact information
Practice address
7721 166TH ST, FRESH MEADOWS, NY 11366-1232
(646) 267-2409
(516) 213-2732
Mailing address
7721 166TH ST, FRESH MEADOWS, NY 11366-1232
(646) 267-2409
(516) 213-2732
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
222Z00000X
Orthotist
Primary
—
NY
224Z00000X
Occupational Therapy Assistant
004659
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02864
AMERICAN BOARD CERTIFIED FITTER- ORTHOTICS
NY
Enumeration date
07/17/2008
Last updated
10/13/2009
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