Healthcare Provider Details

I. General information

NPI: 1174564967
Provider Name (Legal Business Name): HEALTHY FUTURES PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 PROFESSIONAL CIR SUITE 107
COLTS NECK NJ
07722-2426
US

IV. Provider business mailing address

55 RUSTIC WAY
FREEHOLD NJ
07728-9008
US

V. Phone/Fax

Practice location:
  • Phone: 731-462-7511
  • Fax: 732-462-2822
Mailing address:
  • Phone: 732-863-0807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA058185
License Number StateNJ

VIII. Authorized Official

Name: DR. TAMMY BETH MAKOWSKY
Title or Position: OWNER
Credential: MD
Phone: 732-462-7511