Provider Demographics
NPI:1730653569
Name:DIALLO, OUSMANE
Entity Type:Individual
Prefix:
First Name:OUSMANE
Middle Name:
Last Name:DIALLO
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 1:673 DAWSON ST APT 15
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-2428
Mailing Address - Country:US
Mailing Address - Phone:718-415-5364
Mailing Address - Fax:
Practice Address - Street 1:673 DAWSON ST APT 15
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-2428
Practice Address - Country:US
Practice Address - Phone:718-415-5364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY685794163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse