Provider Demographics
NPI:1235288937
Name:DONALD J SALZBERG, MD
Entity Type:Organization
Organization Name:DONALD J SALZBERG, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SALZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-233-2346
Mailing Address - Street 1:836 FARMINGTON AVE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1505
Mailing Address - Country:US
Mailing Address - Phone:860-233-2346
Mailing Address - Fax:
Practice Address - Street 1:836 FARMINGTON AVE
Practice Address - Street 2:SUITE 121
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1505
Practice Address - Country:US
Practice Address - Phone:860-233-2346
Practice Address - Fax:860-233-2346
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DONALD J SALZBERG, MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-10
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
CT025635207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4212289Medicaid
CT4212289Medicaid