Healthcare Provider Details

I. General information

NPI: 1184370686
Provider Name (Legal Business Name): MR. ROBERT JAMES SALTANOVITZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 MARINERS DR
WARSAW IN
46582-7145
US

IV. Provider business mailing address

PO BOX 824246
PHILADELPHIA PA
19182-4246
US

V. Phone/Fax

Practice location:
  • Phone: 850-985-9180
  • Fax:
Mailing address:
  • Phone: 850-985-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28216375A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: