Healthcare Provider Details

I. General information

NPI: 1245908045
Provider Name (Legal Business Name): MR. MAKOR AFET
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2021
Last Update Date: 09/06/2021
Certification Date: 09/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 TURTLE ST
SYRACUSE NY
13208-1637
US

IV. Provider business mailing address

707 TURTLE ST
SYRACUSE NY
13208-1637
US

V. Phone/Fax

Practice location:
  • Phone: 786-202-7962
  • Fax:
Mailing address:
  • Phone: 786-202-7962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number877344545
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: