Provider Demographics
NPI:1861815011
Name:SALAMACK, ANJA (NPP)
Entity Type:Individual
Prefix:
First Name:ANJA
Middle Name:
Last Name:SALAMACK
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 WOLF RD
Mailing Address - Street 2:108
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-2151
Mailing Address - Country:US
Mailing Address - Phone:518-526-6713
Mailing Address - Fax:518-730-0235
Practice Address - Street 1:125 WOLF RD
Practice Address - Street 2:108
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-2151
Practice Address - Country:US
Practice Address - Phone:518-526-6713
Practice Address - Fax:518-730-0235
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401680-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health