Provider Demographics
NPI:1477593614
Name:SALAMA, FAWZY W (MD)
Entity Type:Individual
Prefix:DR
First Name:FAWZY
Middle Name:W
Last Name:SALAMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FAWZY
Other - Middle Name:WASFY
Other - Last Name:SALAMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:175 JERICHO TURNPIKE 114
Mailing Address - Street 2:114
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791
Mailing Address - Country:US
Mailing Address - Phone:516-558-7353
Mailing Address - Fax:516-558-7354
Practice Address - Street 1:175 JERICHO TPKE STE 114
Practice Address - Street 2:114
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4501
Practice Address - Country:US
Practice Address - Phone:516-558-7353
Practice Address - Fax:516-558-7354
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1976032084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01714272Medicaid
NY01714272Medicaid
NY186393K511Medicare PIN
NY01714272Medicaid