Healthcare Provider Details

I. General information

NPI: 1760887988
Provider Name (Legal Business Name): JUMMAI MEMUNA IBRAHIM ALO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3582 CANAL AVE
BROOKLYN NY
11224-1686
US

IV. Provider business mailing address

3582 CANAL AVE
BROOKLYN NY
11224-1686
US

V. Phone/Fax

Practice location:
  • Phone: 917-889-0037
  • Fax:
Mailing address:
  • Phone: 917-889-0037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number318230
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number816642
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: