Provider Demographics
NPI:1659776854
Name:ABDALLAH, NIDAL
Entity Type:Individual
Prefix:
First Name:NIDAL
Middle Name:
Last Name:ABDALLAH
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 1:1 VALLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:STANHOPE
Mailing Address - State:NJ
Mailing Address - Zip Code:07874
Mailing Address - Country:US
Mailing Address - Phone:973-725-4994
Mailing Address - Fax:
Practice Address - Street 1:1 VALLEY RD
Practice Address - Street 2:
Practice Address - City:STANHOPE
Practice Address - State:NJ
Practice Address - Zip Code:07874-2844
Practice Address - Country:US
Practice Address - Phone:973-725-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12046100163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant