Provider Demographics
NPI:1205169331
Name:MAK, RICHARD (PT)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:MAK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E 55TH ST
Mailing Address - Street 2:SUITE 5D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4038
Mailing Address - Country:US
Mailing Address - Phone:212-759-4553
Mailing Address - Fax:212-935-5025
Practice Address - Street 1:155 E 55TH ST
Practice Address - Street 2:SUITE 5D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4038
Practice Address - Country:US
Practice Address - Phone:212-759-4553
Practice Address - Fax:212-935-5025
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01330700225100000X
NY031571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist