Provider Demographics
NPI:1376857177
Name:SALLOUM, AZIZEH J (MD)
Entity Type:Individual
Prefix:
First Name:AZIZEH
Middle Name:J
Last Name:SALLOUM
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 1:53 S LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-1946
Mailing Address - Country:US
Mailing Address - Phone:856-451-4700
Mailing Address - Fax:856-794-7183
Practice Address - Street 1:1200 N HIGH ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-2540
Practice Address - Country:US
Practice Address - Phone:856-451-4700
Practice Address - Fax:856-794-7183
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09206900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine