Provider Demographics
NPI:1740552462
Name:COURTNEY SALAMONE DOM PA
Entity type:Organization
Organization Name:COURTNEY SALAMONE DOM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAMONE
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:561-862-8948
Mailing Address - Street 1:1010 NE 8TH AVE
Mailing Address - Street 2:APT 35
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5853
Mailing Address - Country:US
Mailing Address - Phone:561-862-8948
Mailing Address - Fax:
Practice Address - Street 1:208 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-3847
Practice Address - Country:US
Practice Address - Phone:561-862-8948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2308261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center