Provider Demographics
NPI:1871754879
Name:ELHABASH, SALEEM IBRAHIM (MD)
Entity type:Individual
Prefix:
First Name:SALEEM
Middle Name:IBRAHIM
Last Name:ELHABASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 LONGWOOD AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5221
Mailing Address - Country:US
Mailing Address - Phone:857-492-1755
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST # CA034
Practice Address - Street 2:BWHSURGERY EDUCATION SUITE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-6861
Practice Address - Fax:617-264-6850
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA236024390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program