Provider Demographics
NPI:1891315529
Name:ABI-SALEH, SIMON PETER
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:PETER
Last Name:ABI-SALEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 GRANT STREET, MED ED PODIUM 4
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-0120
Mailing Address - Country:US
Mailing Address - Phone:203-384-4442
Mailing Address - Fax:
Practice Address - Street 1:267 GRANT STREET, MED ED PODIUM 4
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-0120
Practice Address - Country:US
Practice Address - Phone:203-384-4442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT75727207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program