Provider Demographics
NPI:1245618719
Name:SALEH, ALI
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:SALEH
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 1:14 CAYUGA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE HIAWATHA
Mailing Address - State:NJ
Mailing Address - Zip Code:07034
Mailing Address - Country:US
Mailing Address - Phone:973-917-3223
Mailing Address - Fax:973-917-3224
Practice Address - Street 1:14 CAYUGA AVE
Practice Address - Street 2:
Practice Address - City:LAKE HIAWATHA
Practice Address - State:NJ
Practice Address - Zip Code:07034-1902
Practice Address - Country:US
Practice Address - Phone:973-917-3223
Practice Address - Fax:973-917-3224
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ100614172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver