Provider Demographics
NPI:1689910911
Name:MICHAEL SALAMATBAD D.O. PC
Entity Type:Organization
Organization Name:MICHAEL SALAMATBAD D.O. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAMATBAD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-439-5060
Mailing Address - Street 1:212 MIDDLE NECK RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1136
Mailing Address - Country:US
Mailing Address - Phone:516-439-5060
Mailing Address - Fax:516-869-4247
Practice Address - Street 1:212 MIDDLE NECK RD
Practice Address - Street 2:SUITE 7
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1136
Practice Address - Country:US
Practice Address - Phone:516-439-5060
Practice Address - Fax:516-869-4247
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL SALAMATBAD D.O. PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249405261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care