Provider Demographics
NPI:1780756619
Name:MAKOWSKI, CHARLES JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:MAKOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BRIELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08730
Mailing Address - Country:US
Mailing Address - Phone:732-528-5626
Mailing Address - Fax:732-528-6856
Practice Address - Street 1:608 UNION AVE
Practice Address - Street 2:
Practice Address - City:BRIELLE
Practice Address - State:NJ
Practice Address - Zip Code:08730
Practice Address - Country:US
Practice Address - Phone:732-528-5626
Practice Address - Fax:732-528-6856
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02539100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2786800Medicaid
041805Medicare ID - Type Unspecified
NJ2786800Medicaid