Provider Demographics
NPI:1114671385
Name:MAKENAH LLC
Entity Type:Organization
Organization Name:MAKENAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MADGE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEURIMOND CEMELUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-668-6269
Mailing Address - Street 1:1507 E LAS OLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2345
Mailing Address - Country:US
Mailing Address - Phone:516-668-6269
Mailing Address - Fax:
Practice Address - Street 1:1507 E LAS OLAS BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2345
Practice Address - Country:US
Practice Address - Phone:516-668-6269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Single Specialty