Healthcare Provider Details

I. General information

NPI: 1902366917
Provider Name (Legal Business Name): JEFFREY SALEMI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 MALCOLM X BLVD
BROOKLYN NY
11233-1800
US

IV. Provider business mailing address

55 WATER STREET 2ND FLOOR CRED DEPT
NEW YORK NY
10041-0010
US

V. Phone/Fax

Practice location:
  • Phone: 646-741-7200
  • Fax:
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number316331
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: