Provider Demographics
NPI:1407870298
Name:SALIB, BOUSHRA (MD)
Entity Type:Individual
Prefix:MR
First Name:BOUSHRA
Middle Name:
Last Name:SALIB
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 1:651 W MOUNT PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1600
Mailing Address - Country:US
Mailing Address - Phone:973-740-9396
Mailing Address - Fax:973-251-1165
Practice Address - Street 1:2 KINGS HWY E
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-3509
Practice Address - Country:US
Practice Address - Phone:732-957-0707
Practice Address - Fax:732-706-9558
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04196200207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ584548Medicare ID - Type Unspecified
NJD19504Medicare UPIN