Provider Demographics
NPI:1316104086
Name:SALAMATBAD, MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SALAMATBAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 MIDDLE NECK RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1136
Mailing Address - Country:US
Mailing Address - Phone:516-319-1274
Mailing Address - Fax:
Practice Address - Street 1:212 MIDDLE NECK RD
Practice Address - Street 2:SUITE 7
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1136
Practice Address - Country:US
Practice Address - Phone:516-319-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2494051207Q00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program