Provider Demographics
NPI:1710767322
Name:SALT ON MAIN LLC
Entity Type:Organization
Organization Name:SALT ON MAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:SHORTT
Authorized Official - Last Name:SCHEMBARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-776-7258
Mailing Address - Street 1:575 MAIN ST STE 149
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4353
Mailing Address - Country:US
Mailing Address - Phone:301-776-7258
Mailing Address - Fax:
Practice Address - Street 1:575 MAIN ST STE 149
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4353
Practice Address - Country:US
Practice Address - Phone:301-776-7258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty