Provider Demographics
NPI:1558444760
Name:MAKAROVSKAYA, MARINA (MD)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:MAKAROVSKAYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WEAVER ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-5403
Mailing Address - Country:US
Mailing Address - Phone:718-614-2282
Mailing Address - Fax:
Practice Address - Street 1:2076 HYLAN BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3427
Practice Address - Country:US
Practice Address - Phone:718-979-4865
Practice Address - Fax:718-979-1842
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02841647Medicaid