Provider Demographics
NPI:1326216912
Name:ELIZABETH O. SALCEDO, MDPC
Entity type:Organization
Organization Name:ELIZABETH O. SALCEDO, MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:O
Authorized Official - Last Name:SALCEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-625-9000
Mailing Address - Street 1:PO BOX 461
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-0461
Mailing Address - Country:US
Mailing Address - Phone:732-625-9000
Mailing Address - Fax:763-647-2898
Practice Address - Street 1:200 CRAIG RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8735
Practice Address - Country:US
Practice Address - Phone:732-625-9000
Practice Address - Fax:763-647-2898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ037194Medicare PIN