Healthcare Provider Details

I. General information

NPI: 1366428831
Provider Name (Legal Business Name): JAVIER SALABARRIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 MASONIC AVE
WALLINGFORD CT
06492-3095
US

IV. Provider business mailing address

67 MASONIC AVE
WALLINGFORD CT
06492-3095
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-5720
  • Fax: 203-679-5623
Mailing address:
  • Phone: 203-265-5720
  • Fax: 203-679-5623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number038434
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: