Healthcare Provider Details

I. General information

NPI: 1548289309
Provider Name (Legal Business Name): ALAN ABRAHAM SALEM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 LONG BEACH RD SUITE#1
OCEANSIDE NY
11572-3240
US

IV. Provider business mailing address

3051 LONG BEACH RD SUITE#1
OCEANSIDE NY
11572-3240
US

V. Phone/Fax

Practice location:
  • Phone: 516-536-2000
  • Fax: 516-764-0257
Mailing address:
  • Phone: 516-536-2000
  • Fax: 516-764-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number185047-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: