Provider Demographics
NPI:1942894928
Name:MAGRADZE, MAYA
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:MAGRADZE
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 1:296 ELIZABETH ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3590
Mailing Address - Country:US
Mailing Address - Phone:646-419-0122
Mailing Address - Fax:646-559-4938
Practice Address - Street 1:296 ELIZABETH ST APT 2R
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3590
Practice Address - Country:US
Practice Address - Phone:646-419-0122
Practice Address - Fax:646-559-4938
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty