Provider Demographics
NPI:1689676397
Name:SALAMON, ITAMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ITAMAR
Middle Name:
Last Name:SALAMON
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 1:102 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1751
Mailing Address - Country:US
Mailing Address - Phone:914-948-6816
Mailing Address - Fax:914-206-3597
Practice Address - Street 1:102 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1751
Practice Address - Country:US
Practice Address - Phone:914-948-6816
Practice Address - Fax:914-206-3597
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0846482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0044871OtherGHI
NY00127899Medicaid
NY00127899Medicaid
NYB16910Medicare UPIN