Healthcare Provider Details

I. General information

NPI: 1346473923
Provider Name (Legal Business Name): YOHANNES ALEMU D.O, M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DRIVE UMDNJ-SOM
STRATFORD NJ
08084
US

IV. Provider business mailing address

320 W BRANCH AVE APT 11E
PINE HILL NJ
08021-6006
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-7121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS017245
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: