Healthcare Provider Details

I. General information

NPI: 1124882279
Provider Name (Legal Business Name): BASSSAM J SALAM CEO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BANTA PL STE 201
HACKENSACK NJ
07601-5605
US

IV. Provider business mailing address

10 BANTA PL STE 201
HACKENSACK NJ
07601-5605
US

V. Phone/Fax

Practice location:
  • Phone: 862-249-8353
  • Fax:
Mailing address:
  • Phone: 862-249-8353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278H0200X
TaxonomyHome Health Certified Respiratory Therapist
License NumberHP0345100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: