Basic Information
| Provider Information | |||||||||
| NPI: | 1952537847 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALIBA | ||||||||
| FirstName: | JABBAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 134 HOMER AVE | ||||||||
| Address2: | |||||||||
| City: | CORTLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130451206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077588019 | ||||||||
| FaxNumber: | 6077588210 | ||||||||
| Practice Location | |||||||||
| Address1: | 1259 FISHER AVE | ||||||||
| Address2: | |||||||||
| City: | CORTLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130451012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077531017 | ||||||||
| FaxNumber: | 6077531091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2009 | ||||||||
| LastUpdateDate: | 11/29/2016 | ||||||||
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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 | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208600000X | 43355 | TN | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 286667 | NY | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1532556 | 05 | TN | MEDICAID | 4630541 | 01 | TN | BCBS-TN | OTHER |