Provider Demographics
NPI:1922354216
Name:VIELOT, MACKLAINE M
Entity Type:Individual
Prefix:MS
First Name:MACKLAINE
Middle Name:M
Last Name:VIELOT
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 1:2855 OCEAN AVE
Mailing Address - Street 2:2F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3165
Mailing Address - Country:US
Mailing Address - Phone:718-877-6914
Mailing Address - Fax:
Practice Address - Street 1:827 CLARKSON AVE
Practice Address - Street 2:TOP FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2256
Practice Address - Country:US
Practice Address - Phone:718-735-7151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11024171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1992903736Medicaid