Provider Demographics
NPI:1063177590
Name:MAKI, MONROE
Entity type:Individual
Prefix:
First Name:MONROE
Middle Name:
Last Name:MAKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 DUBOIS RD
Mailing Address - Street 2:
Mailing Address - City:SHOKAN
Mailing Address - State:NY
Mailing Address - Zip Code:12481-5105
Mailing Address - Country:US
Mailing Address - Phone:845-750-0448
Mailing Address - Fax:
Practice Address - Street 1:33 DUBOIS RD
Practice Address - Street 2:
Practice Address - City:SHOKAN
Practice Address - State:NY
Practice Address - Zip Code:12481-5105
Practice Address - Country:US
Practice Address - Phone:845-750-0448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-31
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer