=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881259380
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADEL ALHAJ SALEH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2019
-----------------------------------------------------
Last Update Date | 06/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 NICOLLS ROAD HEALTH SCIENCES CENTER, T-19 ROOM 053
-----------------------------------------------------
City | STONY BROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11794-8191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-444-8330
-----------------------------------------------------
Fax | 631-638-0050
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 NICOLLS ROAD HEALTH SCIENCES CENTER, T-19 ROOM 053
-----------------------------------------------------
City | STONY BROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11794-8191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-444-8330
-----------------------------------------------------
Fax | 631-638-0050
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 336015
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------