Healthcare Provider Details

I. General information

NPI: 1295079234
Provider Name (Legal Business Name): DANIEL RAOUL SALTZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3182 FAIRCHILD AVE UNIT E
JBER AK
99506-1545
US

IV. Provider business mailing address

745 BREWERTON RD BOX 3843
WEST POINT NY
10996-1602
US

V. Phone/Fax

Practice location:
  • Phone: 734-904-9575
  • Fax:
Mailing address:
  • Phone: 734-904-9575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number413026
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number1620749
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: