Healthcare Provider Details

I. General information

NPI: 1568661304
Provider Name (Legal Business Name): YELENA MAKAROV MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 VICTORY BLVD
STATEN ISLAND NY
10314-3529
US

IV. Provider business mailing address

1534 VICTORY BLVD
STATEN ISLAND NY
10314-3529
US

V. Phone/Fax

Practice location:
  • Phone: 718-720-7400
  • Fax: 718-720-1806
Mailing address:
  • Phone: 718-720-7400
  • Fax: 718-720-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number222551
License Number StateNY

VIII. Authorized Official

Name: DR. YELENA MAKAROV
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-720-7400