Provider Demographics
NPI:1760577704
Name:GIRARDI, SAL (MD)
Entity Type:Individual
Prefix:
First Name:SAL
Middle Name:
Last Name:GIRARDI
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 1:1000 10TH AVE
Mailing Address - Street 2:SUITE 3B-20
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1147
Mailing Address - Country:US
Mailing Address - Phone:212-523-6598
Mailing Address - Fax:212-523-8262
Practice Address - Street 1:1000 10TH AVE
Practice Address - Street 2:SUITE 3B-20
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1147
Practice Address - Country:US
Practice Address - Phone:212-523-6598
Practice Address - Fax:212-523-8262
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176106-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01472297Medicaid
NYF27667Medicare UPIN
NY40K911Medicare ID - Type Unspecified