Provider Demographics
NPI:1396958617
Name:RANDY D MAKOVSKY MD PC
Entity type:Organization
Organization Name:RANDY D MAKOVSKY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MAKOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-482-3530
Mailing Address - Street 1:475 NORTHERN BLVD
Mailing Address - Street 2:STE 26
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4802
Mailing Address - Country:US
Mailing Address - Phone:516-482-3530
Mailing Address - Fax:516-829-2654
Practice Address - Street 1:475 NORTHERN BLVD
Practice Address - Street 2:STE 26
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4802
Practice Address - Country:US
Practice Address - Phone:516-482-3530
Practice Address - Fax:516-829-2654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120852208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWS4401Medicare ID - Type Unspecified