Provider Demographics
NPI:1447212154
Name:SALVATORE, AUGUST G (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:AUGUST
Middle Name:G
Last Name:SALVATORE
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MOUNTAIN BLVD EXT
Mailing Address - Street 2:STE 209
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059
Mailing Address - Country:US
Mailing Address - Phone:732-469-7290
Mailing Address - Fax:732-469-7917
Practice Address - Street 1:65 MOUNTAIN BLVD EXT
Practice Address - Street 2:STE 209
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059
Practice Address - Country:US
Practice Address - Phone:732-469-7290
Practice Address - Fax:732-469-7917
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04503700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1416308Medicaid
D96748Medicare UPIN
NJ451758Medicare ID - Type Unspecified