Basic Information
Provider Information
NPI: 1750355376
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SALEH
FirstName: GEORGE
MiddleName: F
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4372 ROUTE 6
Address2:  
City: KANE
State: PA
PostalCode: 167353060
CountryCode: US
TelephoneNumber: 8148378585
FaxNumber: 8148377992
Practice Location
Address1: 4372 ROUTE 6
Address2:  
City: KANE
State: PA
PostalCode: 167353060
CountryCode: US
TelephoneNumber: 8148378585
FaxNumber: 8148377992
Other Information
ProviderEnumerationDate: 02/13/2006
LastUpdateDate: 05/27/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/27/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XRN263237LPAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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