Provider Demographics
NPI:1720001829
Name:SALITA, AGATONA BELEN (MD)
Entity Type:Individual
Prefix:
First Name:AGATONA
Middle Name:BELEN
Last Name:SALITA
Suffix:
Gender:F
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:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NJ
Mailing Address - Zip Code:08240-0515
Mailing Address - Country:US
Mailing Address - Phone:609-748-5380
Mailing Address - Fax:609-652-8749
Practice Address - Street 1:61 W JIMMY LEEDS RD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08240
Practice Address - Country:US
Practice Address - Phone:609-748-5380
Practice Address - Fax:609-652-8749
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA24795208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
E70680Medicare UPIN
5A456010Medicare ID - Type Unspecified