Provider Demographics
NPI:1568661304
Name:YELENA MAKAROV MD PC
Entity Type:Organization
Organization Name:YELENA MAKAROV MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKAROV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-720-7400
Mailing Address - Street 1:1534 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3529
Mailing Address - Country:US
Mailing Address - Phone:718-720-7400
Mailing Address - Fax:718-720-1806
Practice Address - Street 1:1534 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3529
Practice Address - Country:US
Practice Address - Phone:718-720-7400
Practice Address - Fax:718-720-1806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222551173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH66374Medicare UPIN