Provider Demographics
NPI:1528107315
Name:HAQUE, SALMA (MD)
Entity type:Individual
Prefix:DR
First Name:SALMA
Middle Name:
Last Name:HAQUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 ROUTE 88
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3018
Mailing Address - Country:US
Mailing Address - Phone:732-836-3135
Mailing Address - Fax:732-836-3144
Practice Address - Street 1:1314 HOOPER AVE
Practice Address - Street 2:BLDG B 2ND FLOOR
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2975
Practice Address - Country:US
Practice Address - Phone:732-349-4994
Practice Address - Fax:732-341-1717
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04195100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110213997OtherRAILROAD MEDICARE
C56745Medicare UPIN
NJ520590Medicare PIN