Healthcare Provider Details

I. General information

NPI: 1376129882
Provider Name (Legal Business Name): ASHRAF SALEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 RIVERSIDE DR
BINGHAMTON NY
13905-4246
US

IV. Provider business mailing address

169 RIVERSIDE DR
BINGHAMTON NY
13905-4246
US

V. Phone/Fax

Practice location:
  • Phone: 607-798-5280
  • Fax:
Mailing address:
  • Phone: 607-798-5280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME168307
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: