Individual
IVAN MAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
22205 56TH AVE, BAYSIDE, NY 11364-1432
(718) 281-5191
Mailing address
222-19 B 69 AVE., OAKLAND GARDENS, NY 11364
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
002005-1
NY
Other
Enumeration date
10/29/2020
Last updated
10/29/2020
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