Healthcare Provider Details

I. General information

NPI: 1275480360
Provider Name (Legal Business Name): TADJOU DINE AYINDE ALAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 BERGEN ST
BROOKLYN NY
11217-4040
US

IV. Provider business mailing address

473 BERGEN ST
BROOKLYN NY
11217-4040
US

V. Phone/Fax

Practice location:
  • Phone: 929-312-7138
  • Fax: 347-778-5933
Mailing address:
  • Phone: 929-312-7138
  • Fax: 347-778-5933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number365334865
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License NumberB03728
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: