Healthcare Provider Details

I. General information

NPI: 1225139595
Provider Name (Legal Business Name): PAUL W. SALERNO M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 DIVISION STREET
AMSTERDAM NY
12010-4099
US

IV. Provider business mailing address

67 DIVISION STREET
AMSTERDAM NY
12010-4099
US

V. Phone/Fax

Practice location:
  • Phone: 518-842-2723
  • Fax: 518-842-6573
Mailing address:
  • Phone: 518-842-2723
  • Fax: 518-842-6573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number211842-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number008771
License Number StateNY

VIII. Authorized Official

Name: DR. PAUL WILLIAM SALERNO
Title or Position: MEDICAL DOCTOR/EXECUTIVE OFFICER
Credential: M.D.
Phone: 518-842-2723