Provider Demographics
NPI:1962455303
Name:SALERNO, SIMON A (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:A
Last Name:SALERNO
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 1:2101 ROUTE 34
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-9104
Mailing Address - Country:US
Mailing Address - Phone:732-974-0003
Mailing Address - Fax:732-974-0443
Practice Address - Street 1:2101 ROUTE 34
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-9104
Practice Address - Country:US
Practice Address - Phone:732-974-0003
Practice Address - Fax:732-974-0443
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA83858207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ125869UVPMedicare PIN
NJI57668Medicare UPIN