=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942242318
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GAMIL MAKAR MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2006
-----------------------------------------------------
Last Update Date | 06/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 ROUTE 3 WEST
-----------------------------------------------------
City | CLIFTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 862-249-4901
-----------------------------------------------------
Fax | 973-928-2650
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1700 ROUTE 3
-----------------------------------------------------
City | CLIFTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07013-3928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 862-249-4901
-----------------------------------------------------
Fax | 973-928-2650
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. GAMIL LAMEY MAKAR
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 862-249-4901
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 25MA07631500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------