Healthcare Provider Details

I. General information

NPI: 1538413893
Provider Name (Legal Business Name): MR. OSMAN JALLOH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 N BLACK HORSE PIKE STE G
WILLIAMSTOWN NJ
08094-3465
US

IV. Provider business mailing address

1951 N BLACK HORSE PIKE STE G
WILLIAMSTOWN NJ
08094-3465
US

V. Phone/Fax

Practice location:
  • Phone: 856-625-5805
  • Fax:
Mailing address:
  • Phone: 856-625-5805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00395900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: