Provider Demographics
NPI:1588606560
Name:MAKOWSKI, DAVID (PHD)
Entity type:Individual
Prefix:PROF
First Name:DAVID
Middle Name:
Last Name:MAKOWSKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-632-3785
Mailing Address - Fax:
Practice Address - Street 1:169 PUTNAM HALL
Practice Address - Street 2:STONY BROOK UNIVERSITY - SOUTH CAMPUS
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-1595
Practice Address - Country:US
Practice Address - Phone:631-632-3096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012396103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01905393Medicaid
NYV83841Medicare UPIN
NYA400022773Medicare PIN