Provider Demographics
NPI:1336335413
Name:SALVATORE M. LARAIA, MD, PA
Entity Type:Organization
Organization Name:SALVATORE M. LARAIA, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-944-7676
Mailing Address - Street 1:1625 ANDERSON AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2748
Mailing Address - Country:US
Mailing Address - Phone:201-944-7676
Mailing Address - Fax:201-944-9452
Practice Address - Street 1:1625 ANDERSON AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2748
Practice Address - Country:US
Practice Address - Phone:201-944-7676
Practice Address - Fax:201-944-9452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07477500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH78264Medicare UPIN
NJLA723971Medicare PIN
NJD18575Medicare UPIN
NJE62864Medicare UPIN