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General NPI Number Information
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NPI Number | 1912184615
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Entity Type | Organization
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Legal Business Name | MICHAEL MAK MEDICAL PC
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Dates
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Enumeration Date | 01/24/2008
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 712A BEACH 20 ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691
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Country | US
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Telephone | 718-327-5400
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Fax | 718-327-5434
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Provider Business Mailing Address
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Address Line | 712A BEACH 20 STREET
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691
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Country | US
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Telephone | 718-327-5400
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Fax | 718-327-5434
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL MAK
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Credential | M.D.
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Telephone | 718-327-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 211790-1
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License Number State | NY
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