Provider Demographics
NPI:1598720559
Name:SALERNO, JOSEPH ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ROY
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 1:8800 S OCEAN DR APT 305
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-2144
Mailing Address - Country:US
Mailing Address - Phone:772-229-8367
Mailing Address - Fax:772-229-8367
Practice Address - Street 1:8800 S OCEAN DR APT 305
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-2144
Practice Address - Country:US
Practice Address - Phone:772-229-8367
Practice Address - Fax:772-229-8367
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 64484174400000X
PAMD044368L207K00000X, 208000000X
NJMA0249770208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes174400000XOther Service ProvidersSpecialist
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJSA547595Medicare ID - Type Unspecified
NJ0738808Medicaid
E71929Medicare UPIN