Provider Demographics
NPI:1225316565
Name:KOROMA, SALAMATU (LPN)
Entity Type:Individual
Prefix:
First Name:SALAMATU
Middle Name:
Last Name:KOROMA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BEGONIA CT
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-2129
Mailing Address - Country:US
Mailing Address - Phone:173-264-2443
Mailing Address - Fax:
Practice Address - Street 1:20 BEGONIA CT
Practice Address - Street 2:
Practice Address - City:SAYREVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08872-2129
Practice Address - Country:US
Practice Address - Phone:732-642-4436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP06602200164W00000X
NY777225163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse