MEDICARE: HEBA MAKBOUL PHYSICIAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	033661	NY
2	225100000X	Physical Therapist	028209	NY

General Provider Information

NPI Number	:	1336322387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEBA MAKBOUL PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	5823 83RD ST APT 2
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-5496
Country	:	US
Telephone Number	:	646-724-3899
Fax Number	:	718-424-5070

Provider Business Practice Location Address
First Line	:	3540 82ND ST STE 1D
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-5106
Country	:	US
Telephone Number	:	718-507-5800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	11/12/2025

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