Provider Demographics
NPI:1821595034
Name:SIMILHOMME, MAKENSY (APN)
Entity Type:Individual
Prefix:
First Name:MAKENSY
Middle Name:
Last Name:SIMILHOMME
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 1:257 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-9222
Mailing Address - Country:US
Mailing Address - Phone:908-868-7347
Mailing Address - Fax:
Practice Address - Street 1:257 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-9222
Practice Address - Country:US
Practice Address - Phone:908-868-7347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00738600363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care