Provider Demographics
NPI:1407258171
Name:SALLAM, HAITHAM (DPT)
Entity Type:Individual
Prefix:DR
First Name:HAITHAM
Middle Name:
Last Name:SALLAM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4002
Mailing Address - Country:US
Mailing Address - Phone:929-485-6000
Mailing Address - Fax:929-210-7000
Practice Address - Street 1:87 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4002
Practice Address - Country:US
Practice Address - Phone:929-485-6000
Practice Address - Fax:929-210-7000
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist