Healthcare Provider Details

I. General information

NPI: 1366684896
Provider Name (Legal Business Name): MINA MAKARYUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 10/29/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 LAKEVILLE ROAD SUITE 107
NEW HYDE PARK NY
11040
US

IV. Provider business mailing address

410 LAKEVILLE ROAD SUITE 107
NEW HYDE PARK NY
11040
US

V. Phone/Fax

Practice location:
  • Phone: 516-424-1536
  • Fax:
Mailing address:
  • Phone: 516-465-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number259676
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number259676
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: