Provider Demographics
NPI:1598109316
Name:ABDEL-SALAM, HESHAM H (PT)
Entity Type:Individual
Prefix:
First Name:HESHAM
Middle Name:H
Last Name:ABDEL-SALAM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 CRESCENT ST
Mailing Address - Street 2:APT L1
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4114
Mailing Address - Country:US
Mailing Address - Phone:607-222-8794
Mailing Address - Fax:
Practice Address - Street 1:1401 E 4TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3504
Practice Address - Country:US
Practice Address - Phone:786-259-0300
Practice Address - Fax:866-665-8671
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034946-1225100000X
FLPT32293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY034946-1OtherLICENSE#
FLPT32293OtherPHYSICAL THERAPIST