Provider Demographics
NPI:1225139595
Name:PAUL W. SALERNO M.D., P.C.
Entity Type:Organization
Organization Name:PAUL W. SALERNO M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR/EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SALERNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-842-2723
Mailing Address - Street 1:67 DIVISION STREET
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-4099
Mailing Address - Country:US
Mailing Address - Phone:518-842-2723
Mailing Address - Fax:518-842-6573
Practice Address - Street 1:67 DIVISION STREET
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-4099
Practice Address - Country:US
Practice Address - Phone:518-842-2723
Practice Address - Fax:518-842-6573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211842-1208100000X
NY008771225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01927022Medicaid
NY02516934Medicaid
NYRA8560Medicare PIN
NYG84755Medicare UPIN
NY01927022Medicaid
NY5403820001Medicare NSC
NYBA0117Medicare PIN