Provider Demographics
NPI:1225390602
Name:ZAKAREYSHVILI, MARIKA (MSED)
Entity Type:Individual
Prefix:MRS
First Name:MARIKA
Middle Name:
Last Name:ZAKAREYSHVILI
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BOULDER ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2239
Mailing Address - Country:US
Mailing Address - Phone:646-338-8744
Mailing Address - Fax:
Practice Address - Street 1:120 BOULDER ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2239
Practice Address - Country:US
Practice Address - Phone:646-338-8744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist