Provider Demographics
NPI:1407225196
Name:SALOM, ANDRES (REEGT)
Entity Type:Individual
Prefix:MR
First Name:ANDRES
Middle Name:
Last Name:SALOM
Suffix:
Gender:M
Credentials:REEGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 RIVER POINT WAY
Mailing Address - Street 2:APT 6103
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843
Mailing Address - Country:US
Mailing Address - Phone:617-888-9311
Mailing Address - Fax:
Practice Address - Street 1:115 RIVER POINTE WAY
Practice Address - Street 2:APT 6103
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-3853
Practice Address - Country:US
Practice Address - Phone:617-888-9311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5361246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic