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General NPI Number Information
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NPI Number | 1396958617
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Entity Type | Organization
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Legal Business Name | RANDY D MAKOVSKY MD PC
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 475 NORTHERN BLVD STE 26
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City | GREAT NECK
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State | NY
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Zip | 11021-4802
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Country | US
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Telephone | 516-482-3530
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Fax | 516-829-2654
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Provider Business Mailing Address
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Address Line | 475 NORTHERN BLVD STE 26
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City | GREAT NECK
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State | NY
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Zip | 11021-4802
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Country | US
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Telephone | 516-482-3530
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Fax | 516-829-2654
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Authorized Official
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Title or Position | OWNER
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Name | DR. RANDY DAVID MAKOVSKY
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Credential | MD
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Telephone | 516-482-3530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 120852
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License Number State | NY
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