Provider Demographics
NPI:1871610006
Name:MAKAHILIG, RUEL GONZALES
Entity type:Individual
Prefix:
First Name:RUEL
Middle Name:GONZALES
Last Name:MAKAHILIG
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 1:61 WINDING WOOD DR APT 1A
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-2019
Mailing Address - Country:US
Mailing Address - Phone:732-642-2168
Mailing Address - Fax:732-254-2462
Practice Address - Street 1:1806 RTE 35
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-2700
Practice Address - Country:US
Practice Address - Phone:732-660-1113
Practice Address - Fax:732-660-1152
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01101200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ115064SWGMedicare PIN