Healthcare Provider Details

I. General information

NPI: 1174352603
Provider Name (Legal Business Name): SALEM MICHAEL AKKE LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 MAIN ST
HACKENSACK NJ
07601-5704
US

IV. Provider business mailing address

2000 LINWOOD AVE APT 10R
FORT LEE NJ
07024-3007
US

V. Phone/Fax

Practice location:
  • Phone: 646-763-4682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT01503600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: