Provider Demographics
NPI:1730596057
Name:SALEEM MAHMOOD, M.D.
Entity type:Organization
Organization Name:SALEEM MAHMOOD, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SALEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-432-5744
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
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALEEM MAHMOOD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7065507Medicaid
NJG33080Medicare UPIN