Provider Demographics
NPI:1760139380
Name:SALAZAR, BIANJELY MERCEDES
Entity Type:Individual
Prefix:
First Name:BIANJELY
Middle Name:MERCEDES
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3439 BRUCKNER BLVD
Mailing Address - Street 2:2F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461
Mailing Address - Country:US
Mailing Address - Phone:718-675-0395
Mailing Address - Fax:
Practice Address - Street 1:125 E BETHPAGE RD STE 5
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4228
Practice Address - Country:US
Practice Address - Phone:718-631-1119
Practice Address - Fax:718-631-1314
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency