Healthcare Provider Details

I. General information

NPI: 1528522208
Provider Name (Legal Business Name): ELIM MAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2019
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2089 3RD AVE
NEW YORK NY
10029-2184
US

IV. Provider business mailing address

2089 3RD AVE
NEW YORK NY
10029-2184
US

V. Phone/Fax

Practice location:
  • Phone: 212-828-6144
  • Fax:
Mailing address:
  • Phone: 908-379-9623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number001642
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: