MEDICARE: TADJOU DINE AYINDE ALAO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	365334865	NY

General Provider Information

NPI Number	:	1275480360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TADJOU DINE AYINDE ALAO

Provider Business Mailing Address
First Line	:	473 BERGEN ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-4040
Country	:	US
Telephone Number	:	929-312-7138
Fax Number	:	347-778-5933

Provider Business Practice Location Address
First Line	:	473 BERGEN ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-4040
Country	:	US
Telephone Number	:	929-312-7138
Fax Number	:	347-778-5933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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