Provider Demographics
NPI:1912922451
Name:SALEEM, MOHAMED FAWZY (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:FAWZY
Last Name:SALEEM
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 1:800 CASTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1819
Mailing Address - Country:US
Mailing Address - Phone:718-354-3344
Mailing Address - Fax:718-354-3334
Practice Address - Street 1:800 CASTLETON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1819
Practice Address - Country:US
Practice Address - Phone:718-354-3344
Practice Address - Fax:718-354-3334
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00223670Medicaid
NYB18939Medicare UPIN
NY00223670Medicaid
NY712251Medicare ID - Type Unspecified