Provider Demographics
NPI:1205197563
Name:SALVADOR DEOCAMPO JR
Entity type:Organization
Organization Name:SALVADOR DEOCAMPO JR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SALVADOR
Authorized Official - Middle Name:DARIARTE
Authorized Official - Last Name:DEOCAMPO
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:347-268-1299
Mailing Address - Street 1:8620 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4830
Mailing Address - Country:US
Mailing Address - Phone:347-268-1299
Mailing Address - Fax:
Practice Address - Street 1:4080 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1542
Practice Address - Country:US
Practice Address - Phone:212-928-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0292433140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric