Basic Information
| Provider Information | |||||||||
| NPI: | 1871754879 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELHABASH | ||||||||
| FirstName: | SALEEM | ||||||||
| MiddleName: | IBRAHIM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 57 LONGWOOD AVE APT 4 | ||||||||
| Address2: | |||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024465221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8574921755 | ||||||||
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| Practice Location | |||||||||
| Address1: | 75 FRANCIS ST # CA034 | ||||||||
| Address2: | BWHSURGERY EDUCATION SUITE | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021156110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177326861 | ||||||||
| FaxNumber: | 6172646850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2008 | ||||||||
| LastUpdateDate: | 06/23/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 236024 | MA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.