MEDICARE: DR. FAWZY W. SALAMA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	197603	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477593614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAWZY W. SALAMA MD

Provider Business Mailing Address
First Line	:	175 JERICHO TURNPIKE 114
Second Line	:	114
City	:	SYOSSET
State	:	NY
Zip	:	11791
Country	:	US
Telephone Number	:	516-558-7353
Fax Number	:	516-558-7354

Provider Business Practice Location Address
First Line	:	175 JERICHO TPKE STE 114
Second Line	:	114
City	:	SYOSSET
State	:	NY
Zip	:	11791-4501
Country	:	US
Telephone Number	:	516-558-7353
Fax Number	:	516-558-7354

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	11/13/2014

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