Provider Demographics
NPI:1033413372
Name:SALMON, ALTHEA JEANENE (RN)
Entity Type:Individual
Prefix:
First Name:ALTHEA
Middle Name:JEANENE
Last Name:SALMON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 MARLBORO RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1415
Mailing Address - Country:US
Mailing Address - Phone:917-440-3559
Mailing Address - Fax:
Practice Address - Street 1:5050 ISELIN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2915
Practice Address - Country:US
Practice Address - Phone:718-549-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY421388-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse