Healthcare Provider Details

I. General information

NPI: 1508779042
Provider Name (Legal Business Name): SALAM5
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 EMMONS AVE APT B17
BROOKLYN NY
11235-2732
US

IV. Provider business mailing address

1725 EMMONS AVE APT B17
BROOKLYN NY
11235-2732
US

V. Phone/Fax

Practice location:
  • Phone: 347-818-1055
  • Fax:
Mailing address:
  • Phone: 347-818-1055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. SALOMAT TADJIYEVA
Title or Position: ABA/SI
Credential: MSED
Phone: 347-818-1055