Healthcare Provider Details

I. General information

NPI: 1043859499
Provider Name (Legal Business Name): EBIAREDO ALOFE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 GARDEN ST
UNION NJ
07083-6642
US

IV. Provider business mailing address

704 GARDEN ST
UNION NJ
07083-6642
US

V. Phone/Fax

Practice location:
  • Phone: 908-472-8042
  • Fax:
Mailing address:
  • Phone: 908-472-8042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number26NR09618800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: