Provider Demographics
NPI:1205816717
Name:SALLOUM, AHMAD (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:SALLOUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 JACK MARTIN BLVD
Mailing Address - Street 2:STE 4
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7724
Mailing Address - Country:US
Mailing Address - Phone:732-458-6200
Mailing Address - Fax:732-458-9464
Practice Address - Street 1:459 JACK MARTIN BLVD STE 2
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7724
Practice Address - Country:US
Practice Address - Phone:732-458-6200
Practice Address - Fax:732-458-9464
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07386207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ057517AAKMedicare PIN