| Bissalam Medical Llc | |
|
3391 3rd Ave Ste 1 Bronx NY 10456-5355 | |
| (347) 299-7967 | |
| Not Available |
| Full Name | Bissalam Medical Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3391 3rd Ave Ste 1, Bronx, New York |
| Authorized Official Name and Position | Luqman O Salahudeen (PHYSICIAN) |
| Authorized Official Contact | 3472997967 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bissalam Medical Llc Po Box 783 Bronx NY 10456-0525 Ph: (347) 299-7967 | Bissalam Medical Llc 3391 3rd Ave Ste 1 Bronx NY 10456-5355 Ph: (347) 299-7967 |
| NPI Number | 1154988897 |
|---|---|
| Provider Enumeration Date | 05/28/2019 |
| Last Update Date | 05/28/2019 |
| Medicare PECOS PAC ID | 4486985090 |
|---|---|
| Medicare Enrollment ID | O20191014000808 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154988897 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Luqman Salahudeen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487087193 PECOS PAC ID: 2466713318 Enrollment ID: I20180309001820 |
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