Provider Demographics
NPI:1912184615
Name:MICHAEL MAK MEDICAL PC
Entity Type:Organization
Organization Name:MICHAEL MAK MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-327-5400
Mailing Address - Street 1:712A BEACH 20 STREET
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691
Mailing Address - Country:US
Mailing Address - Phone:718-327-5400
Mailing Address - Fax:718-327-5434
Practice Address - Street 1:712A BEACH 20 ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:718-327-5400
Practice Address - Fax:718-327-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211790-1207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00182147OtherRAILROAD MEDICARE
NY2514262OtherGHI
NY05679MOtherMEDICARE GHI
NYP2927481OtherOXFORD
NY08326GOtherGHI MEDICARE
IL9815737OtherBLUE CROSS BLUE SHIELD
NY2Z224Medicare PIN
NY2514262OtherGHI