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General NPI Number Information
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NPI Number | 1124755673
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Entity Type | Individual
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Provider Name | SEMYON MAKAGON
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Gender | Male
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 2579 E 17TH ST STE 18
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City | BROOKLYN
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State | NY
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Zip | 11235-3515
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Country | US
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Telephone | 347-286-1779
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Fax |
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Provider Business Mailing Address
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Address Line | 2302 AVENUE U UNIT 290147
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City | BROOKLYN
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State | NY
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Zip | 11229-7504
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Country | US
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Telephone | 347-286-1779
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 116935
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License Number State | NY
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