Healthcare Provider Details

I. General information

NPI: 1245684950
Provider Name (Legal Business Name): ETA SALTZBURG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 REGENCY CIR
ENGLEWOOD NJ
07631-5045
US

IV. Provider business mailing address

8 REGENCY CIR
ENGLEWOOD NJ
07631-5045
US

V. Phone/Fax

Practice location:
  • Phone: 917-224-3189
  • Fax:
Mailing address:
  • Phone: 917-224-3189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: