Provider Demographics
NPI:1184786949
Name:DEGLIUOMINI, SALVATORE JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:JOHN
Last Name:DEGLIUOMINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7220 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5141
Mailing Address - Country:US
Mailing Address - Phone:718-232-3512
Mailing Address - Fax:718-837-7815
Practice Address - Street 1:7220 17TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5141
Practice Address - Country:US
Practice Address - Phone:718-232-3512
Practice Address - Fax:718-837-7815
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY164098207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE17639Medicare UPIN