Provider Demographics
NPI:1912250903
Name:MATEIKO, KRISTIN ELIZABETH
Entity Type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:ELIZABETH
Last Name:MATEIKO
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 1:3815 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2331
Mailing Address - Country:US
Mailing Address - Phone:516-993-1194
Mailing Address - Fax:
Practice Address - Street 1:67-25 188TH ST
Practice Address - Street 2:LITTLE MEADOWS
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365
Practice Address - Country:US
Practice Address - Phone:718-454-6460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY659218121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist