Provider Demographics
NPI:1821308701
Name:MAZAL M MATAYEV SLP PC
Entity Type:Organization
Organization Name:MAZAL M MATAYEV SLP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MAZAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MATAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:MACCCSLP
Authorized Official - Phone:718-208-7911
Mailing Address - Street 1:7323 179TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1603
Mailing Address - Country:US
Mailing Address - Phone:718-208-7911
Mailing Address - Fax:917-210-3200
Practice Address - Street 1:7323 179TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1603
Practice Address - Country:US
Practice Address - Phone:718-208-7911
Practice Address - Fax:917-210-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services