Provider Demographics
NPI:1720961113
Name:MANSOUR, SALSABYL AHMED (OD)
Entity type:Individual
Prefix:
First Name:SALSABYL
Middle Name:AHMED
Last Name:MANSOUR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 GLENWILD AVE # B
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07403-1413
Mailing Address - Country:US
Mailing Address - Phone:908-969-8477
Mailing Address - Fax:
Practice Address - Street 1:500 ROUTE 23
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1853
Practice Address - Country:US
Practice Address - Phone:973-616-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00738000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist