Provider Demographics
NPI:1275244196
Name:MAKHARADZE, NINO
Entity Type:Individual
Prefix:
First Name:NINO
Middle Name:
Last Name:MAKHARADZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 NETHERLAND AVE APT 910
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2098
Mailing Address - Country:US
Mailing Address - Phone:164-698-1749
Mailing Address - Fax:
Practice Address - Street 1:2600 NETHERLAND AVE APT 910
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-2098
Practice Address - Country:US
Practice Address - Phone:164-698-1749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty