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General NPI Number Information
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NPI Number | 1972023265
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Entity Type | Individual
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Provider Name | MARYAM ALETAN
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Gender | Female
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Dates
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Enumeration Date | 06/27/2017
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 1135 BROAD ST STE 2
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City | CLIFTON
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State | NJ
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Zip | 07013-3346
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Country | US
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Telephone | 888-244-5373
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Fax |
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Provider Business Mailing Address
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Address Line | 82 GOURLEY AVE
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City | CLIFTON
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State | NJ
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Zip | 07013-1038
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number | 25MA11928000
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License Number State | NJ
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