Individual
MARINA MATATOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4037 74TH ST, ELMHURST, NY 11373-5603
(718) 651-7000
(718) 606-8966
Mailing address
4037 74TH ST, ELMHURST, NY 11373-5603
(718) 651-7000
(718) 606-8966
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
259160
NY
390200000X
Student in an Organized Health Care Education/Training Program
259160
NY
Other
Enumeration date
09/21/2011
Last updated
11/10/2020
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