Provider Demographics
NPI:1881986263
Name:SALIEB, LORRAINE O (MD)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:O
Last Name:SALIEB
Suffix:
Gender:F
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:I PLAZA DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080
Mailing Address - Country:US
Mailing Address - Phone:856-270-4080
Mailing Address - Fax:
Practice Address - Street 1:1 PLAZA DR
Practice Address - Street 2:BUNKER HILL PLAZA
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9207
Practice Address - Country:US
Practice Address - Phone:856-270-4080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09507000207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program