Provider Demographics
NPI:1558043141
Name:YASSA-MAKAR, BRIAN E
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
Last Name:YASSA-MAKAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1317
Mailing Address - Country:US
Mailing Address - Phone:201-577-8110
Mailing Address - Fax:
Practice Address - Street 1:1133 INMAN AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1282
Practice Address - Country:US
Practice Address - Phone:908-753-0624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04296600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist