Provider Demographics
NPI:1447641469
Name:MATATOV, ALEX SOLOMON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:SOLOMON
Last Name:MATATOV
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15910 71ST AVE
Mailing Address - Street 2:#8A
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3020
Mailing Address - Country:US
Mailing Address - Phone:646-797-7491
Mailing Address - Fax:
Practice Address - Street 1:159-10 71ST AVE.
Practice Address - Street 2:#8A
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-3020
Practice Address - Country:US
Practice Address - Phone:646-797-7491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060186183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist