MEDICARE: TATYANA MAKAREVITCH MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255R0406X	Blind Rehabilitation Specialist/Technologist	780B	NY

General Provider Information

NPI Number	:	1528343787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATYANA MAKAREVITCH MA

Provider Business Mailing Address
First Line	:	3917 WILLOW PL
Second Line	:
City	:	LITTLE NECK
State	:	NY
Zip	:	11363-1614
Country	:	US
Telephone Number	:	917-734-9264
Fax Number	:

Provider Business Practice Location Address
First Line	:	3917 WILLOW PL
Second Line	:
City	:	LITTLE NECK
State	:	NY
Zip	:	11363-1614
Country	:	US
Telephone Number	:	917-734-9264
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	10/21/2011

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Directions to “ TATYANA MAKAREVITCH MA” Practice Location

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