Provider Demographics
NPI:1831238898
Name:SALUCK, KEVIN ALAN (DPM)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ALAN
Last Name:SALUCK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2070 SPRINGDALE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2043
Mailing Address - Country:US
Mailing Address - Phone:856-751-9222
Mailing Address - Fax:856-866-8632
Practice Address - Street 1:2070 SPRINGDALE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2043
Practice Address - Country:US
Practice Address - Phone:856-751-9222
Practice Address - Fax:856-751-3374
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MD00258600213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MD00258600OtherLICENSE #
148037Medicare ID - Type Unspecified
NJT29617Medicare UPIN