Provider Demographics
NPI:1104014372
Name:SALERNO, MIRIAM (RN)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:SALERNO
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 1:12 HARBOR HILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2903
Mailing Address - Country:US
Mailing Address - Phone:631-751-2118
Mailing Address - Fax:
Practice Address - Street 1:12 HARBOR HILL RD
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2903
Practice Address - Country:US
Practice Address - Phone:631-751-2118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY423239163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02519244Medicaid