Healthcare Provider Details

I. General information

NPI: 1962163766
Provider Name (Legal Business Name): ALEM DJUKIC NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

2812 ROSEWOOD LANE
OAKVILLE ONTARIO
L6J7M5
CA

V. Phone/Fax

Practice location:
  • Phone: 351-464-5540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number432218
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: