Active NPI
Heidi Matisoff, NP
- Primary Care Nurse Practitioner
- New York, NY
National Provider Identifier
1609267376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Nurse Practitioner
- License
- F306939-1
- Practice address
- 4781 Broadway
New York, NY 10034-4915 - Phone
- (212) 304-6920
- Fax
- (212) 544-5849
- NPI assigned
- Feb 16, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | F306939-1 | NY | Primary |
Addresses
Primary practice location
4781 Broadway
New York, NY 10034-4915
Mailing address
4781 Broadway
New York, NY 10034-4915
Phone (212) 304-6920
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04093050 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F306939-1 | NY | MD | Primary Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The New York and Presbyterian Hospital | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- White Plains, NY
- NPI 1457057226
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456963200000",
"number": "1609267376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4781 BROADWAY",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100344915",
"telephone_number": "212-304-6920",
"fax_number": "212-544-5849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4781 BROADWAY",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100344915",
"telephone_number": "212-304-6920",
"fax_number": "212-544-5849"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATISOFF",
"first_name": "HEIDI",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-02-16",
"last_updated": "2016-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "363LP2300X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Primary Care",
"state": "NY",
"license": "F306939-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "04093050",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.