Provider Demographics
NPI:1164406229
Name:SALZBERG, PAUL D (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:SALZBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 899
Mailing Address - Street 2:
Mailing Address - City:CALLICOON
Mailing Address - State:NY
Mailing Address - Zip Code:12723-0899
Mailing Address - Country:US
Mailing Address - Phone:845-887-6112
Mailing Address - Fax:845-887-6245
Practice Address - Street 1:9741 ST RT 97
Practice Address - Street 2:
Practice Address - City:CALLICOON
Practice Address - State:NY
Practice Address - Zip Code:12723-0899
Practice Address - Country:US
Practice Address - Phone:845-887-6112
Practice Address - Fax:845-887-6245
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00778318Medicaid
NY00778318Medicaid
NY98A781Medicare PIN