Provider Demographics
NPI:1700290269
Name:FIORENTINO, SALVATORE JR (ND)
Entity Type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:
Last Name:FIORENTINO
Suffix:JR
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 413
Mailing Address - Street 2:
Mailing Address - City:GREENS FARMS
Mailing Address - State:CT
Mailing Address - Zip Code:06838
Mailing Address - Country:US
Mailing Address - Phone:203-864-5762
Mailing Address - Fax:
Practice Address - Street 1:163 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3307
Practice Address - Country:US
Practice Address - Phone:203-864-5762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT515175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath