Provider Demographics
NPI:1568347151
Name:JALLOH, MARIAMA (FNP)
Entity type:Individual
Prefix:
First Name:MARIAMA
Middle Name:
Last Name:JALLOH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 N 7TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-2954
Mailing Address - Country:US
Mailing Address - Phone:973-392-0127
Mailing Address - Fax:
Practice Address - Street 1:44 GLENWOOD AVE STE 201
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1557
Practice Address - Country:US
Practice Address - Phone:973-673-6100
Practice Address - Fax:973-673-7780
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15369900363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care