Provider Demographics
NPI:1891093829
Name:SALEEB, MARIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:
Last Name:SALEEB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIAM
Other - Middle Name:
Other - Last Name:YOUSSEF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1006 MANTUA PIKE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08097
Mailing Address - Country:US
Mailing Address - Phone:856-845-0535
Mailing Address - Fax:856-845-0535
Practice Address - Street 1:1006 MANTUA PIKE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08097-1221
Practice Address - Country:US
Practice Address - Phone:856-846-8600
Practice Address - Fax:856-845-0535
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA101759002084N0400X
PAMD4610812084N0400X
NY2531922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03373966Medicaid
A400052435Medicare PIN
NYA400052435Medicare PIN