Provider Demographics
NPI:1982647038
Name:BACUS, SALEEM (MD)
Entity Type:Individual
Prefix:DR
First Name:SALEEM
Middle Name:
Last Name:BACUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10124 131ST ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2347
Mailing Address - Country:US
Mailing Address - Phone:718-441-1793
Mailing Address - Fax:
Practice Address - Street 1:ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL RAHWAY
Practice Address - Street 2:865 STONE STREET
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065
Practice Address - Country:US
Practice Address - Phone:732-381-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232114207P00000X
NJ25MA07803500207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ141985Medicare UPIN
NY141985Medicare UPIN