Provider Demographics
NPI:1306819149
Name:SALIK, EREZ (MD)
Entity Type:Individual
Prefix:DR
First Name:EREZ
Middle Name:
Last Name:SALIK
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 1:49 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-4501
Mailing Address - Country:US
Mailing Address - Phone:203-861-2381
Mailing Address - Fax:203-983-3318
Practice Address - Street 1:49 LAKE AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-4501
Practice Address - Country:US
Practice Address - Phone:203-861-2381
Practice Address - Fax:203-983-3318
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0432992085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT300004043OtherMEDICARE
I33560Medicare UPIN