Provider Demographics
NPI:1376715342
Name:SALOMON, AVIVA BAILA (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:AVIVA
Middle Name:BAILA
Last Name:SALOMON
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 14TH AVE
Mailing Address - Street 2:#4D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3150
Mailing Address - Country:US
Mailing Address - Phone:718-436-1827
Mailing Address - Fax:
Practice Address - Street 1:4901 14TH AVE
Practice Address - Street 2:#4D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3150
Practice Address - Country:US
Practice Address - Phone:718-436-1827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-30
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012439363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant