MEDICARE: DR. ERIC MAKOLO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	190317	NY
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	190317	NY
3	207RP1001X	Pulmonary Disease Physician	190317	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	P2120827	OTHER	OXFORD HEALTH PLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	9640822	OTHER	G.H.I.
4	5248234003	OTHER	CIGNA HEALTHCARE PPO
5	2466949	OTHER	AETNA US HEALTHCARE HMO (
6	0000201801001	OTHER	UNITED HEALTHCARE
7	7521135	OTHER	AETNA US HEALTHCARE PPO
8	2475623	OTHER	AETNA US HEALTHCARE HMO (
9	2C9321	OTHER	HEALTHNET
10	524823030	OTHER	CIGNA HEALTHCARE HMO
11	190317	OTHER	HIP

General Provider Information

NPI Number	:	1558359935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC MAKOLO MD

Provider Business Mailing Address
First Line	:	105 STEVENS AVE
Second Line	:	SUITE 609
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-2686
Country	:	US
Telephone Number	:	914-663-6663
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 STEVENS AVE
Second Line	:	SUITE 609
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-2686
Country	:	US
Telephone Number	:	914-663-6663
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	07/23/2012

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