Provider Demographics
NPI:1710195326
Name:MAKARYUS, LYDIA ADEL (DO)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:ADEL
Last Name:MAKARYUS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:ADEL
Other - Last Name:GERGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:711 STEWART AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4757
Mailing Address - Country:US
Mailing Address - Phone:516-742-4015
Mailing Address - Fax:
Practice Address - Street 1:711 STEWART AVE STE 140
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-742-4015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2493272084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry