1780411587 NPI number — HADIATOU DIALLO'S PRIMARY & MENTAL CARE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780411587 NPI number — HADIATOU DIALLO'S PRIMARY & MENTAL CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HADIATOU DIALLO'S PRIMARY & MENTAL CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780411587
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 WILLOWBROOK BLVD STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07470-7033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-618-6623
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 DUNCAN AVE APT 503
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07304-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-618-6623
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2024

Additional Information

Authorized Official

Authorized Official Last Name:
DIALLO
Authorized Official First Name:
IBRAHIMA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
201-618-6623

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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