Provider Demographics
NPI:1700991247
Name:MAHMOOD, SALEEM (MD)
Entity Type:Individual
Prefix:
First Name:SALEEM
Middle Name:
Last Name:MAHMOOD
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 1:66 EMERALD VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-3443
Mailing Address - Country:US
Mailing Address - Phone:201-432-5744
Mailing Address - Fax:201-432-2720
Practice Address - Street 1:8 JORDAN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-432-5744
Practice Address - Fax:201-432-2720
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA64358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7065507Medicaid
NJ7065507Medicaid
G33080Medicare UPIN