Healthcare Provider Details

I. General information

NPI: 1144517921
Provider Name (Legal Business Name): GHADIR SALAME MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6740 4TH AVE
BROOKLYN NY
11220-5350
US

IV. Provider business mailing address

6740 4TH AVE
BROOKLYN NY
11220-5350
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number246666
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number246666
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: