Provider Demographics
NPI:1194776435
Name:SALOB, STACY P (MD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:P
Last Name:SALOB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:225 E 64TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-6690
Mailing Address - Country:US
Mailing Address - Phone:212-317-1100
Mailing Address - Fax:212-317-1391
Practice Address - Street 1:361 STERLING RD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1320
Practice Address - Country:US
Practice Address - Phone:914-967-7224
Practice Address - Fax:914-967-7225
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY187578207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY218321Medicare PIN