Provider Demographics
NPI:1992844120
Name:SALUS MED NEW YORK PC
Entity Type:Organization
Organization Name:SALUS MED NEW YORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:MANZANO
Authorized Official - Last Name:VILLONGCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-351-6473
Mailing Address - Street 1:123 E 88TH ST APT 5A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1185
Mailing Address - Country:US
Mailing Address - Phone:646-351-6473
Mailing Address - Fax:646-351-6473
Practice Address - Street 1:1090 AMSTERDAM AVE
Practice Address - Street 2:SUITE 5F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1737
Practice Address - Country:US
Practice Address - Phone:646-409-3557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220788207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01722150Medicaid
NY01722150Medicaid