Healthcare Provider Details

I. General information

NPI: 1467823443
Provider Name (Legal Business Name): MEDICAL OFFICE OF FAWZY WASFY SALAMA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 JERICHO TPKE SUITE 411
SYOSSET NY
11791-4532
US

IV. Provider business mailing address

175 JERICHO TPKE SUITE 411
SYOSSET NY
11791-4532
US

V. Phone/Fax

Practice location:
  • Phone: 516-558-7353
  • Fax: 631-893-4020
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number197603
License Number StateNY

VIII. Authorized Official

Name: DEBRA COANE
Title or Position: OFFICE MANAGER
Credential:
Phone: 631-681-4754