Provider Demographics
NPI:1952287021
Name:MATATOV, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MATATOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 196TH PL
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1813
Mailing Address - Country:US
Mailing Address - Phone:347-634-2854
Mailing Address - Fax:
Practice Address - Street 1:7350 196TH PL
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1813
Practice Address - Country:US
Practice Address - Phone:347-634-2854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program