Basic Information
| Provider Information | |||||||||
| NPI: | 1396786992 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAKOWSKI | ||||||||
| FirstName: | SUZANA | ||||||||
| MiddleName: | KATARINA EVERETT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 KINGS HWY S | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146175504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857237870 | ||||||||
| FaxNumber: | 5857237871 | ||||||||
| Practice Location | |||||||||
| Address1: | 1555 LONG POND RD | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146264122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857237870 | ||||||||
| FaxNumber: | 5857237871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 08/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 18124 | NH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 312610 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0002X | 18124 | NH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 207RH0002X | 312610 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 207R00000X | 230451 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3108787 | 05 | NH | MEDICAID |