MEDICARE: SIMON PETER ABI-SALEH

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	207R00000X	Internal Medicine Physician	75727	CT
2	390200000X	Student in an Organized Health Care Education/Training Program
3	208M00000X	Hospitalist Physician	75727	CT

General Provider Information

NPI Number	:	1891315529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMON PETER ABI-SALEH

Provider Business Mailing Address
First Line	:	267 GRANT STREET, MED ED PODIUM 4
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06610-0120
Country	:	US
Telephone Number	:	203-384-4442
Fax Number	:

Provider Business Practice Location Address
First Line	:	267 GRANT STREET, MED ED PODIUM 4
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06610-0120
Country	:	US
Telephone Number	:	203-384-4442
Fax Number	:

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

Provider Enumeration Date	:	04/22/2020
Last Update Date	:	09/17/2025

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