Provider Demographics
NPI:1093487928
Name:MENASIS-MATUZA, NURSE PRACTITIONER IN PEDIATRICS, PC
Entity Type:Organization
Organization Name:MENASIS-MATUZA, NURSE PRACTITIONER IN PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:NASIS-MATUZA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RN, CPNP
Authorized Official - Phone:516-314-2717
Mailing Address - Street 1:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-0863
Mailing Address - Country:US
Mailing Address - Phone:347-762-7671
Mailing Address - Fax:
Practice Address - Street 1:66 AUSTIN BLVD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5733
Practice Address - Country:US
Practice Address - Phone:347-762-7671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty