Provider Demographics
NPI:1225053580
Name:SALOB, LAWRENCE (DO)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:SALOB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TERRY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3811
Mailing Address - Country:US
Mailing Address - Phone:631-979-7400
Mailing Address - Fax:631-979-7440
Practice Address - Street 1:100 TERRY RD STE 309
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3811
Practice Address - Country:US
Practice Address - Phone:631-979-7400
Practice Address - Fax:631-979-7440
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02868082Medicaid
NYI18834Medicare UPIN