Healthcare Provider Details

I. General information

NPI: 1760903926
Provider Name (Legal Business Name): FIKRY B SALIB MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LONG WHARF DR STE 212
NEW HAVEN CT
06511-5593
US

IV. Provider business mailing address

PO BOX 270
MASSAPEQUA PARK NY
11762-0270
US

V. Phone/Fax

Practice location:
  • Phone: 203-624-4208
  • Fax: 203-624-4301
Mailing address:
  • Phone: 631-264-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FIKRY SALIB
Title or Position: OWNER
Credential: M.D.
Phone: 203-249-3307