Provider Demographics
NPI:1124027750
Name:SALOM, IRA LOUIS (MD)
Entity type:Individual
Prefix:
First Name:IRA
Middle Name:LOUIS
Last Name:SALOM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:979 CROSS BRONX EXPY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-4885
Mailing Address - Country:US
Mailing Address - Phone:718-665-6490
Mailing Address - Fax:718-764-6490
Practice Address - Street 1:979 CROSS BRONX EXPY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4885
Practice Address - Country:US
Practice Address - Phone:718-665-6490
Practice Address - Fax:718-764-6490
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134798207RG0300X, 208U00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA08564600OtherNEW JERSEY LICENSE
NY134798OtherNY MEDICAL LICENSE
B87323Medicare UPIN