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Individual

DIVINE DELE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
201 LYONS AVE, NEWARK, NJ 07112-2027
(862) 440-5173
Mailing address
341 OSBORNE TER APT UNITC, NEWARK, NJ 07112-2064
(862) 440-5173

Taxonomy

Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary

Other

Enumeration date
07/23/2024
Last updated
07/23/2024
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