Provider Demographics
NPI:1063595031
Name:SUSAN L. SALAK, D.P.M., P.C.
Entity type:Organization
Organization Name:SUSAN L. SALAK, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SALAK, D.P.M., P.C.
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-823-0187
Mailing Address - Street 1:34 S MAIN ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-1723
Mailing Address - Country:US
Mailing Address - Phone:570-823-0187
Mailing Address - Fax:570-823-0188
Practice Address - Street 1:34 S MAIN ST
Practice Address - Street 2:SUITE 9
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-1723
Practice Address - Country:US
Practice Address - Phone:570-823-0187
Practice Address - Fax:570-823-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003648L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASA1626367OtherBLUE SHIELD
PA803141OtherHMO
PA0014528270005Medicaid
PA0851310001Medicare NSC
PASA678740Medicare ID - Type Unspecified
PA803141OtherHMO