Provider Demographics
NPI:1396840013
Name:SALCEDO, ELIZABETH O (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:O
Last Name:SALCEDO
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 1:1 ROUTE 70
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5895
Mailing Address - Country:US
Mailing Address - Phone:848-222-4690
Mailing Address - Fax:848-222-4688
Practice Address - Street 1:1 ROUTE 70
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5895
Practice Address - Country:US
Practice Address - Phone:848-222-4690
Practice Address - Fax:848-222-4688
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G14007Medicare UPIN