Provider Demographics
NPI:1699048892
Name:MAKAS, GARY (RRT)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:MAKAS
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5117 UPPER HOLLEY RD
Mailing Address - Street 2:
Mailing Address - City:HOLLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14470-9757
Mailing Address - Country:US
Mailing Address - Phone:585-978-2189
Mailing Address - Fax:
Practice Address - Street 1:5117 UPPER HOLLEY RD
Practice Address - Street 2:
Practice Address - City:HOLLEY
Practice Address - State:NY
Practice Address - Zip Code:14470-9757
Practice Address - Country:US
Practice Address - Phone:585-978-2189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4053-1282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access