Healthcare Provider Details

I. General information

NPI: 1497699334
Provider Name (Legal Business Name): HOWARD MAKOFSKY MT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 COMMERCE PARK
ELLSWORTH ME
04605-3383
US

IV. Provider business mailing address

1211 BROADWAY
BANGOR ME
04401-2503
US

V. Phone/Fax

Practice location:
  • Phone: 207-992-4000
  • Fax: 207-558-3285
Mailing address:
  • Phone: 207-992-4000
  • Fax: 207-558-3285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT8275
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: