Provider Demographics
NPI:1962224493
Name:KOUBEK, SALIMA (FNP)
Entity type:Individual
Prefix:
First Name:SALIMA
Middle Name:
Last Name:KOUBEK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-2336
Mailing Address - Country:US
Mailing Address - Phone:516-491-1661
Mailing Address - Fax:
Practice Address - Street 1:200 CORPORATE PLZ STE A-103
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1552
Practice Address - Country:US
Practice Address - Phone:631-514-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily