Provider Demographics
NPI:1508857566
Name:ALI, SALVATORE (DC)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 BROADWAY
Mailing Address - Street 2:SUITE #3
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-8040
Mailing Address - Country:US
Mailing Address - Phone:201-476-0555
Mailing Address - Fax:201-476-9889
Practice Address - Street 1:136 BROADWAY
Practice Address - Street 2:SUITE #3
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8040
Practice Address - Country:US
Practice Address - Phone:201-476-0555
Practice Address - Fax:201-476-9889
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC00440300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL005314Medicare ID - Type Unspecified
T52265Medicare UPIN