Provider Demographics
NPI:1033664685
Name:AJANAKU-MAKUN, LATEEF (APN)
Entity Type:Individual
Prefix:
First Name:LATEEF
Middle Name:
Last Name:AJANAKU-MAKUN
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 RIDGEWAY ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5129
Mailing Address - Country:US
Mailing Address - Phone:973-342-1160
Mailing Address - Fax:
Practice Address - Street 1:1577 RIDGEWAY ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5129
Practice Address - Country:US
Practice Address - Phone:973-342-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00662300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health