Individual
MADINA IDDRISU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
735 CAULDWELL AVE APT 7K, BRONX, NY 10455-1595
(929) 240-8044
Mailing address
735 CAULDWELL AVE APT 7K, BRONX, NY 10455-1595
(929) 240-8044
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
338951426
STATE ID
NY
Enumeration date
12/01/2022
Last updated
12/01/2022
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