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General NPI Number Information
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NPI Number | 1003107400
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Entity Type | Individual
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Provider Name | GEORGE SALLOUM MD
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Gender | Male
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Dates
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Enumeration Date | 04/20/2011
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 3400 VICKERY RD STE A
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City | NORTH SYRACUSE
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State | NY
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Zip | 13212-4530
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Country | US
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Telephone | 315-422-3937
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2003
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-4503
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Country | US
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Telephone | 154-463-9043
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 265873
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | 265873
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License Number State | NY
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