Provider Demographics
NPI:1376517516
Name:SALERNO, SVETLANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SVETLANA
Middle Name:
Last Name:SALERNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-1950
Mailing Address - Country:US
Mailing Address - Phone:973-672-8573
Mailing Address - Fax:
Practice Address - Street 1:613 PARK AVE.
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1905
Practice Address - Country:US
Practice Address - Phone:973-675-8573
Practice Address - Fax:973-675-0040
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA021418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3823504Medicaid
NJ060153Medicare PIN
NJ3823504Medicaid