Provider Demographics
NPI:1922556265
Name:BUSTAMI, SALAH
Entity Type:Individual
Prefix:
First Name:SALAH
Middle Name:
Last Name:BUSTAMI
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 1:57 W 58TH ST
Mailing Address - Street 2:APT. 3E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1630
Mailing Address - Country:US
Mailing Address - Phone:646-255-7040
Mailing Address - Fax:
Practice Address - Street 1:175 REMSEN ST
Practice Address - Street 2:10TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4333
Practice Address - Country:US
Practice Address - Phone:718-852-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007445101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health