Provider Demographics
NPI:1215238258
Name:SALIS, ROBERTUS J (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTUS
Middle Name:J
Last Name:SALIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6937 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-3022
Mailing Address - Country:US
Mailing Address - Phone:716-298-1107
Mailing Address - Fax:716-298-5737
Practice Address - Street 1:6937 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-3022
Practice Address - Country:US
Practice Address - Phone:716-298-1107
Practice Address - Fax:716-298-5737
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259122208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics