Provider Demographics
NPI:1922285170
Name:SULAYMAN E JALLOW MD PA
Entity Type:Organization
Organization Name:SULAYMAN E JALLOW MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SULAYMAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:JALLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-436-7700
Mailing Address - Street 1:601 N FLAMINGO RD
Mailing Address - Street 2:SUITE 413
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1015
Mailing Address - Country:US
Mailing Address - Phone:954-436-7700
Mailing Address - Fax:954-432-1769
Practice Address - Street 1:601 N FLAMINGO RD
Practice Address - Street 2:SUITE 413
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1015
Practice Address - Country:US
Practice Address - Phone:954-436-7700
Practice Address - Fax:954-432-1769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038394207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066202000Medicaid
FL95749Medicare PIN
FL066202000Medicaid