Healthcare Provider Details

I. General information

NPI: 1922622554
Provider Name (Legal Business Name): ALKINDI MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

872 PREAKNESS AVE
WAYNE NJ
07470-2804
US

IV. Provider business mailing address

2208 QUEENSBURY WAY
FORT SMITH AR
72908-9130
US

V. Phone/Fax

Practice location:
  • Phone: 973-342-4806
  • Fax:
Mailing address:
  • Phone: 973-342-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOUMA JALOU
Title or Position: CEO/MEDICAL DIRECTOR
Credential: MD
Phone: 973-342-4806