Provider Demographics
NPI:1568715977
Name:MATUSEVICH, KARINA
Entity Type:Individual
Prefix:MS
First Name:KARINA
Middle Name:
Last Name:MATUSEVICH
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 1:8722 BAY PKWY APT C4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-5151
Mailing Address - Country:US
Mailing Address - Phone:646-642-1734
Mailing Address - Fax:
Practice Address - Street 1:8722 BAY PKWY APT C4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5151
Practice Address - Country:US
Practice Address - Phone:646-642-1734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist