Provider Demographics
NPI:1639366701
Name:GILBERT G. MAKABALI, MD PC
Entity Type:Organization
Organization Name:GILBERT G. MAKABALI, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:MAKABALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-569-2828
Mailing Address - Street 1:1471 BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11509-1604
Mailing Address - Country:US
Mailing Address - Phone:516-569-2828
Mailing Address - Fax:516-295-4145
Practice Address - Street 1:1471 BAY BLVD
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11509-1604
Practice Address - Country:US
Practice Address - Phone:516-569-2828
Practice Address - Fax:516-295-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY36786Medicare PIN
NYW1T471Medicare PIN