MEDICARE: DR. ALAN ABRAHAM SALEM M.D.

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	2080A0000X	Pediatric Adolescent Medicine Physician	185047-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	185047-1	OTHER	NY	LICENSE #

General Provider Information

NPI Number	:	1548289309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN ABRAHAM SALEM M.D.

Provider Business Mailing Address
First Line	:	3051 LONG BEACH RD
Second Line	:	SUITE#1
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-3240
Country	:	US
Telephone Number	:	516-536-2000
Fax Number	:	516-764-0257

Provider Business Practice Location Address
First Line	:	3051 LONG BEACH RD
Second Line	:	SUITE#1
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-3240
Country	:	US
Telephone Number	:	516-536-2000
Fax Number	:	516-764-0257

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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