Provider Demographics
NPI:1184633190
Name:ELAHWAL, SALEH A
Entity Type:Individual
Prefix:DR
First Name:SALEH
Middle Name:A
Last Name:ELAHWAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 83RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4512
Mailing Address - Country:US
Mailing Address - Phone:718-748-1122
Mailing Address - Fax:718-748-9400
Practice Address - Street 1:481 83RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4512
Practice Address - Country:US
Practice Address - Phone:718-748-1122
Practice Address - Fax:718-748-9400
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042462332B00000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01161471Medicaid
NY01161471Medicaid
NYD42281Medicare ID - Type UnspecifiedORAL SURGERY