Healthcare Provider Details

I. General information

NPI: 1932914728
Provider Name (Legal Business Name): RELEVIUM NJJSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 STATE ROUTE 23 UNIT 5115
WAYNE NJ
07470-7516
US

IV. Provider business mailing address

1536 STATE ROUTE 23 UNIT 5115
WAYNE NJ
07470-7516
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

VIII. Authorized Official

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