Provider Demographics
NPI:1447228440
Name:SALERNO, PAUL WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WILLIAM
Last Name:SALERNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-4099
Mailing Address - Country:US
Mailing Address - Phone:518-842-2723
Mailing Address - Fax:518-842-6573
Practice Address - Street 1:67 DIVISION ST
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-4099
Practice Address - Country:US
Practice Address - Phone:518-842-2723
Practice Address - Fax:518-842-6573
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211842-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01927022Medicaid
NYG84755Medicare UPIN
NYBB3209Medicare ID - Type Unspecified