Provider Demographics
NPI:1578912531
Name:SALEM, HOSSAMELDIN N (DPT)
Entity Type:Individual
Prefix:DR
First Name:HOSSAMELDIN
Middle Name:N
Last Name:SALEM
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 1:186 BAY 31ST STREET
Mailing Address - Street 2:APT 1B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214
Mailing Address - Country:US
Mailing Address - Phone:347-909-8074
Mailing Address - Fax:
Practice Address - Street 1:235 WYCKOFF AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-5303
Practice Address - Country:US
Practice Address - Phone:718-418-4700
Practice Address - Fax:718-418-7575
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2018-03-17
Deactivation Date:2017-01-25
Deactivation Code:
Reactivation Date:2017-03-21
Provider Licenses
StateLicense IDTaxonomies
NY039800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist