Provider Demographics
NPI:1649206178
Name:MAKAR-PICZKO, ELIZABETH (RPA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MAKAR-PICZKO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 PENFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1756
Mailing Address - Country:US
Mailing Address - Phone:585-598-8567
Mailing Address - Fax:585-388-7273
Practice Address - Street 1:2212 PENFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1756
Practice Address - Country:US
Practice Address - Phone:585-598-8567
Practice Address - Fax:585-388-7273
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1458363A00000X
NY001458363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA1705Medicare PIN
NYR95312Medicare UPIN