Matrix Medical of New York PC
NPI 1639433063ActiveOrganization· Nurse Practitioner· New York, NY
Nurse Practitioner in New York, New York, registered in NPPES in June 2012. The authorized official on file is Stephanie Peterson, Manager Credentialing. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1639433063 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jun 29, 2012 |
| Last updated in NPPES | Oct 9, 2025 |
| Certified by provider | Oct 9, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner Primary | 363L00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (NY) |
|---|
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