Organization
PRIME MINDED CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALIMATA SORE OUEDRAOGO (OWNER)
(216) 235-5484
Entity
Organization
Contact information
Practice address
46-48 CRAWFORD ST APT 3, NEWARK, NJ 07102-1157
(216) 235-5484
Mailing address
46-48 CRAWFORD ST APT 3, NEWARK, NJ 07102-1157
(216) 235-5484
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S65780240061822
DRIVING LICENSE
NJ
Enumeration date
05/19/2022
Last updated
05/19/2022
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