Provider Demographics
NPI:1235172982
Name:SALAZAR, GERARDO H (MD)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:H
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 PARK AVE AND RANDOLPH ROAD
Mailing Address - Street 2:DEPT OF PATHOLOGY
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07061-1272
Mailing Address - Country:US
Mailing Address - Phone:908-668-2270
Mailing Address - Fax:908-226-4540
Practice Address - Street 1:1200 PARK AVE AND RANDOLPH ROAD
Practice Address - Street 2:DEPT OF PATHOLOGY
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07061-1272
Practice Address - Country:US
Practice Address - Phone:908-668-2270
Practice Address - Fax:908-226-4540
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02622500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3488501Medicaid
NJ095328Medicare ID - Type Unspecified
NJD19987Medicare UPIN