Healthcare Provider Details

I. General information

NPI: 1366040750
Provider Name (Legal Business Name): GREGORY JOSEPH SALAMON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E EVESHAM RD STE 407
VOORHEES NJ
08043-4505
US

IV. Provider business mailing address

2301 E EVESHAM RD STE 407
VOORHEES NJ
08043-4505
US

V. Phone/Fax

Practice location:
  • Phone: 856-315-4680
  • Fax: 855-538-3166
Mailing address:
  • Phone: 856-315-4680
  • Fax: 855-538-3166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00595700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: