Provider Demographics
NPI:1811066798
Name:J.P. MAKHLOUF M.D. F.A.AP. TIZIANA ANELLO M.D F.A.A.P P.A.
Entity type:Organization
Organization Name:J.P. MAKHLOUF M.D. F.A.AP. TIZIANA ANELLO M.D F.A.A.P P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:IVELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-226-7428
Mailing Address - Street 1:556 EAGLE ROCK AVE
Mailing Address - Street 2:SUITE # 106
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1503
Mailing Address - Country:US
Mailing Address - Phone:973-228-9190
Mailing Address - Fax:973-228-0730
Practice Address - Street 1:556 EAGLE ROCK AVE
Practice Address - Street 2:SUITE # 106
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1503
Practice Address - Country:US
Practice Address - Phone:973-228-9190
Practice Address - Fax:973-228-0730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA032323002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG02299Medicare UPIN