Provider Demographics
NPI:1124882279
Name:SALAM, BASSSAM J (CEO)
Entity type:Individual
Prefix:
First Name:BASSSAM
Middle Name:J
Last Name:SALAM
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10 BANTA PL STE 201
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5605
Mailing Address - Country:US
Mailing Address - Phone:862-249-8353
Mailing Address - Fax:
Practice Address - Street 1:10 BANTA PL STE 201
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5605
Practice Address - Country:US
Practice Address - Phone:862-249-8353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP03451002278H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health