Provider Demographics
NPI:1366040750
Name:SALAMON, GREGORY JOSEPH (PA-C)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:JOSEPH
Last Name:SALAMON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 BELAIRE TER
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2703
Mailing Address - Country:US
Mailing Address - Phone:856-905-2821
Mailing Address - Fax:
Practice Address - Street 1:3131 ROUTE 38
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9757
Practice Address - Country:US
Practice Address - Phone:856-866-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00595700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant