Provider Demographics
NPI:1487849865
Name:STACY P SALOB MD PLLC
Entity Type:Organization
Organization Name:STACY P SALOB MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:P
Authorized Official - Last Name:SALOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-317-1100
Mailing Address - Street 1:115 EAST 61ST STREET
Mailing Address - Street 2:SUITE #7E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065
Mailing Address - Country:US
Mailing Address - Phone:212-317-1100
Mailing Address - Fax:212-317-1391
Practice Address - Street 1:115 EAST 61ST STREET
Practice Address - Street 2:SUITE #7E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:212-317-1100
Practice Address - Fax:212-317-1391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187578207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWGW001Medicare PIN