Individual provider Active NPI

William Mak, D.O.

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Stony Brook, NY
National Provider Identifier
1811256258
Registry record updated Mar 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
279661 Issued in NY
Practice address
Suny at Stony Brook Department of Pediatrics
HSC T-11 / 040
Stony Brook, NY 11794-8111
Phone
(631) 444-2020
Fax
(631) 444-2894
NPI assigned
May 4, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 279661 NY Primary
Pediatrics Physician 208000000X 279661 NY

Addresses

Primary practice location

Suny at Stony Brook Department of Pediatrics
HSC T-11 / 040
Stony Brook, NY 11794-8111

Mailing address

Suny at Stony Brook Department of Pediatrics
HSC T-11 / 040
Stony Brook, NY 11794-8111
Phone (631) 444-2020

Other practice location 1

1425 Portland Ave
Rochester, NY 14621-3011
Phone (585) 922-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, FL3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20161028000401 NY Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 6204135049 Reassigns benefits to 4 organizations
I20250314002037 NY Practitioner - Emergency Medicine 6204135049 Reassigns benefits to 1 organization
I20250624003167 FL Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 6204135049 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
279661NYMDPediatric Emergency Medicine (Pediatrics) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Newark Wayne Community Hospital CurrentSince Oct 1, 2016 Accepting new patients
Rochester General Hospital Pediatrics CurrentSince Oct 1, 2016 Accepting new patients
Rochester General Hospital Pediatrics CurrentSince Feb 17, 2025 Accepting new patients
Clifton Springs Sanitarium Co CurrentSince Oct 1, 2016 Accepting new patients
Lifespire, Inc. CurrentSince Aug 22, 2018 Accepting new patients
Newark Wayne Community Hospital CurrentSince Oct 1, 2016 Accepting new patients
North Shore-Lij Medical PC CurrentSince Aug 22, 2018 Accepting new patients
Emergency Medicine Services of FL, LLC CurrentSince Jun 6, 2025 Accepting new patients
Rochester General Hospital CurrentSince Oct 1, 2016 Accepting new patients

Locations

322 SW Pine Island Rd
Cape Coral, FL 33991
Phone (941) 249-6858

14000 Fivay Rd
Hudson, FL 34667
Phone (727) 819-2929

3663 S Miami Ave
Miami, FL 33133
Phone (305) 285-2131

20900 Biscayne Blvd
Miami, FL 33180
Phone (305) 682-7290

105 Tamiami Trl
Fl Tamiami
Port Charlotte, FL 33953

2 Coulter Rd
Clifton Springs, NY 14432
Phone (315) 462-1472

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

26901 76th Ave
#102
New Hyde Park, NY 11040
Phone (718) 470-3495

1200 Driving Park Ave
Newark, NY 14513
Phone (315) 332-2266

300 Community Dr
Plandome, NY 11030

1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122

100 Kings Hwy S
Rochester, NY 14617
Phone (585) 922-0553

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: wmak5588379@nychhc.direct-ci.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741219200000",
    "number": "1811256258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "SUNY AT STONY BROOK DEPARTMENT OF PEDIATRICS",
            "address_2": "HSC T-11 / 040",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117948111",
            "telephone_number": "631-444-2020",
            "fax_number": "631-444-2894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SUNY AT STONY BROOK DEPARTMENT OF PEDIATRICS",
            "address_2": "HSC T-11 / 040",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117948111",
            "telephone_number": "631-444-2020",
            "fax_number": "631-444-2894"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1425 Portland Ave",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "NY",
            "postal_code": "146213011",
            "country_code": "US",
            "telephone_number": "585-922-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAK",
        "first_name": "WILLIAM",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-04",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "NY",
            "license": "279661",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "279661",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.