Healthcare Provider Details

I. General information

NPI: 1336593649
Provider Name (Legal Business Name): MOHAMMED NASSER SALEM M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 W MAIN ST
BOONTON NJ
07005-1166
US

IV. Provider business mailing address

PO BOX 95000 LB#7550
PHILADELPHIA PA
19195-7550
US

V. Phone/Fax

Practice location:
  • Phone: 973-335-8656
  • Fax: 973-335-8986
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA11035200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number25MA11035200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: