Basic Information
Provider Information
NPI: 1790079366
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAKOWSKI
FirstName: DANIEL
MiddleName: JAMES
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 783311
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191783311
CountryCode: US
TelephoneNumber: 4848844500
FaxNumber: 4848840699
Practice Location
Address1: 1250 S CEDAR CREST BLVD STE 300
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181036381
CountryCode: US
TelephoneNumber: 6104023110
FaxNumber: 6104023112
Other Information
ProviderEnumerationDate: 06/01/2011
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XOT013908PAN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RC0000XOS016869PAY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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