Provider Demographics
NPI:1508930173
Name:MAK HEALTHCARE, PC
Entity Type:Organization
Organization Name:MAK HEALTHCARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAGDIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-588-2225
Mailing Address - Street 1:225 ERDMAN ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-2043
Mailing Address - Country:US
Mailing Address - Phone:610-588-2225
Mailing Address - Fax:
Practice Address - Street 1:225 ERDMAN ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-2043
Practice Address - Country:US
Practice Address - Phone:610-588-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X, 207Q00000X, 207R00000X, 208100000X, 208600000X, 225100000X
PA363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50031706OtherCAPITAL BC
PAMA1785117OtherHIGHMARK-MEDICAL
PA3919243OtherAETNA
PA1508930173OtherRAILROAD MEDICARE/PALMETT
PA660979OtherUNITED HC
PAP38305OtherAMERIHEALTH
PAMT1552791OtherHIGHMARK-CHIROPRACTIC
PA2626451000OtherPERSONAL CHOICE
PAMA1785117OtherHIGHMARK-MEDICAL
PA074945Medicare ID - Type UnspecifiedCHIROPRACTIC