Provider Demographics
NPI:1104472042
Name:JALLOH, ALFRED (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:
Last Name:JALLOH
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 PAERDEGAT 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4136
Mailing Address - Country:US
Mailing Address - Phone:718-930-3317
Mailing Address - Fax:
Practice Address - Street 1:4 W RED OAK LN STE 310
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-3606
Practice Address - Country:US
Practice Address - Phone:914-719-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily