Provider Demographics
NPI:1528488335
Name:SALAM, PALOMA (OD)
Entity type:Individual
Prefix:DR
First Name:PALOMA
Middle Name:
Last Name:SALAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GLEASON RD
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-5307
Mailing Address - Country:US
Mailing Address - Phone:518-399-6368
Mailing Address - Fax:
Practice Address - Street 1:9 GLEASON RD
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-5307
Practice Address - Country:US
Practice Address - Phone:518-399-6368
Practice Address - Fax:518-399-6372
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008081152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist