Healthcare Provider Details

I. General information

NPI: 1881795912
Provider Name (Legal Business Name): DR. JEAN MAKHLOUF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 EAGLE ROCK AVE STE# 106
ROSELAND NJ
07068-1503
US

IV. Provider business mailing address

556 EAGLE ROCK AVE STE# 106
ROSELAND NJ
07068-1503
US

V. Phone/Fax

Practice location:
  • Phone: 973-228-9190
  • Fax: 973-228-0730
Mailing address:
  • Phone: 973-228-9190
  • Fax: 973-228-0730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA32323
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: