Provider Demographics
NPI:1336713577
Name:EJ SALAZAR MEDICAL PLLC
Entity type:Organization
Organization Name:EJ SALAZAR MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-229-3390
Mailing Address - Street 1:234 NORTH CENTRAL PARK AVE.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530
Mailing Address - Country:US
Mailing Address - Phone:914-229-3390
Mailing Address - Fax:914-229-3395
Practice Address - Street 1:234 NORTH CENTRAL PARK AVE.
Practice Address - Street 2:SUITE 201
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530
Practice Address - Country:US
Practice Address - Phone:914-229-3390
Practice Address - Fax:914-229-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1467785139OtherNPPS