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General NPI Number Information
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NPI Number | 1417924168
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Entity Type | Individual
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Provider Name | JOHN MAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 06/18/2021
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Provider Practice Location Address
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Address Line | 55 SCHANCK RD SUTE 8A
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City | FREEHOLD
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State | NJ
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Zip | 07728
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Country | US
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Telephone | 732-431-9544
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Fax | 732-431-9313
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Provider Business Mailing Address
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Address Line | 11350 MCCORMICK RD EXECUTIVE PLAZA 1, STE. 501
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City | HUNT VALLEY
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State | MD
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Zip | 21031
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Country | US
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Telephone | 410-329-1071
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Fax | 410-329-1054
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 25MA08226700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 25MA08226700
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 25MA08226700
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License Number State | NJ
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