MEDICARE: SALMAHN AHMED ALAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	278360	NY
2	2084P0800X	Psychiatry Physician	25MA12021900	NJ
3	2084P0804X	Child & Adolescent Psychiatry Physician	25MA12021900	NJ

General Provider Information

NPI Number	:	1174889208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALMAHN AHMED ALAM

Provider Business Mailing Address
First Line	:	645 ROUTE 18 STE 5
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-3760
Country	:	US
Telephone Number	:	888-244-5373
Fax Number	:

Provider Business Practice Location Address
First Line	:	645 ROUTE 18 STE 5
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-3760
Country	:	US
Telephone Number	:	888-244-5373
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2012
Last Update Date	:	03/15/2024

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