Provider Demographics
NPI:1386274058
Name:MAKAYAN, MA VERA GAIL CASTRO
Entity type:Individual
Prefix:
First Name:MA VERA GAIL
Middle Name:CASTRO
Last Name:MAKAYAN
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 1:343 GOLD ST APT 3508
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3099
Mailing Address - Country:US
Mailing Address - Phone:216-233-0040
Mailing Address - Fax:
Practice Address - Street 1:343 GOLD ST APT 3508
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3099
Practice Address - Country:US
Practice Address - Phone:216-233-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019836-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist