Provider Demographics
NPI:1043516636
Name:SALVATORE, PAOLO AUGUSTO (MD)
Entity Type:Individual
Prefix:
First Name:PAOLO
Middle Name:AUGUSTO
Last Name:SALVATORE
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 1:65 MOUNTAIN BLVD EXT STE 209
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5658
Mailing Address - Country:US
Mailing Address - Phone:908-956-3411
Mailing Address - Fax:732-469-7917
Practice Address - Street 1:67 WALNUT AVE # 402A
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1640
Practice Address - Country:US
Practice Address - Phone:732-499-9110
Practice Address - Fax:732-396-8445
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2023-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ390200000X
NJ25MA08997700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program