Provider Demographics
NPI:1154452985
Name:ADALLA, HOMER V
Entity Type:Individual
Prefix:
First Name:HOMER
Middle Name:V
Last Name:ADALLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 TONNELE AVE
Mailing Address - Street 2:APT 3B
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5518
Mailing Address - Country:US
Mailing Address - Phone:973-437-0795
Mailing Address - Fax:
Practice Address - Street 1:32 W 26TH ST
Practice Address - Street 2:FL 2
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-5678
Practice Address - Country:US
Practice Address - Phone:973-437-0795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01179100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist