Provider Demographics
NPI:1508886003
Name:DITTA, SALVADORE (RPA)
Entity Type:Individual
Prefix:MR
First Name:SALVADORE
Middle Name:
Last Name:DITTA
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13664-0176
Mailing Address - Country:US
Mailing Address - Phone:315-375-8224
Mailing Address - Fax:315-394-1417
Practice Address - Street 1:813 STATE ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-3362
Practice Address - Country:US
Practice Address - Phone:315-393-6749
Practice Address - Fax:315-394-1417
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000483-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54153BMedicare ID - Type Unspecified
NYS00179Medicare UPIN