Provider Demographics
NPI:1881646040
Name:SALOB, PETER ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANDREW
Last Name:SALOB
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 1:401 S VAN BRUNT ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4604
Mailing Address - Country:US
Mailing Address - Phone:201-569-2770
Mailing Address - Fax:201-569-1774
Practice Address - Street 1:401 S VAN BRUNT ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4604
Practice Address - Country:US
Practice Address - Phone:201-569-2770
Practice Address - Fax:201-569-1774
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07295700207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0003166Medicaid
051487PF5Medicare PIN
NJ0003166Medicaid