Healthcare Provider Details

I. General information

NPI: 1306651906
Provider Name (Legal Business Name): FORTEMD-NJSSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 WATCHUNG AVE UNIT 147
PLAINFIELD NJ
07060-1251
US

IV. Provider business mailing address

108 WATCHUNG AVE UNIT 147
PLAINFIELD NJ
07060-1251
US

V. Phone/Fax

Practice location:
  • Phone: 973-200-4695
  • Fax: 223-213-2057
Mailing address:
  • Phone: 973-200-4695
  • Fax: 223-213-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MARIAM B SALISU
Title or Position: CHIEF OPERATING OFFICER
Credential: MD
Phone: 240-338-6901