Provider Demographics
NPI:1134165269
Name:SALAMANCA, EDWIN (PA)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:SALAMANCA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 48310
Mailing Address - Street 2:EMERGENCY PHYSICIANS OF EMA INC
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-4810
Mailing Address - Country:US
Mailing Address - Phone:201-894-3450
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:350 ENGLE STREET
Practice Address - Street 2:ENGLEWOOD HOSPITAL
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-984-3000
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2019-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMP00551363A00000X
NY005262207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ037703Medicare ID - Type Unspecified
P06174Medicare UPIN