Basic Information
| Provider Information | |||||||||
| NPI: | 1831147081 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALIB | ||||||||
| FirstName: | TAMER | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2828 CROASDAILE DR | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277052505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662723030 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 BAY AVE | ||||||||
| Address2: | |||||||||
| City: | MONTCLAIR | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070424837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734296991 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 05/19/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 25MB08088600 | NJ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PE0004X | 20A9892 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 0111074 | 05 | NJ | MEDICAID | PENDING | 01 | ALL IDENTIFIERS PENDIG | OTHER |