Provider Demographics
NPI:1376532796
Name:POTOCZEK-SALAHI, JOLANTA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOLANTA
Middle Name:
Last Name:POTOCZEK-SALAHI
Suffix:
Gender:F
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:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:391 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-1330
Practice Address - Country:US
Practice Address - Phone:201-858-4110
Practice Address - Fax:201-858-2240
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06314900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6838006Medicaid
814975Medicare ID - Type Unspecified
NJ6838006Medicaid