Provider Demographics
NPI:1497064372
Name:RAUL P. SALA, MD, PC
Entity Type:Organization
Organization Name:RAUL P. SALA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:PEREZ
Authorized Official - Last Name:SALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-273-8888
Mailing Address - Street 1:11 RALPH PL
Mailing Address - Street 2:SUITE 112
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4401
Mailing Address - Country:US
Mailing Address - Phone:718-273-8888
Mailing Address - Fax:718-727-0971
Practice Address - Street 1:11 RALPH PL
Practice Address - Street 2:SUITE 112
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4401
Practice Address - Country:US
Practice Address - Phone:718-273-8888
Practice Address - Fax:718-727-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1077171B208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00189937Medicaid
C11857Medicare UPIN
NY00189937Medicaid