Provider Demographics
NPI:1780130922
Name:AL-DALAIM, ABDO
Entity type:Individual
Prefix:
First Name:ABDO
Middle Name:
Last Name:AL-DALAIM
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 1:780 PELHAM PKWY S APT A11
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-1103
Mailing Address - Country:US
Mailing Address - Phone:347-220-5441
Mailing Address - Fax:
Practice Address - Street 1:1207 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-4903
Practice Address - Country:US
Practice Address - Phone:718-409-1338
Practice Address - Fax:718-409-4684
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist