Provider Demographics
NPI:1003072356
Name:PHILIP J. MAKOWSKI, MD, PLLC
Entity Type:Organization
Organization Name:PHILIP J. MAKOWSKI, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-395-9144
Mailing Address - Street 1:2 CORACI BLVD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-4833
Mailing Address - Country:US
Mailing Address - Phone:631-395-9144
Mailing Address - Fax:631-395-9167
Practice Address - Street 1:2 CORACI BLVD
Practice Address - Street 2:SUITE 17
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-4833
Practice Address - Country:US
Practice Address - Phone:631-395-9144
Practice Address - Fax:631-395-9167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization