Healthcare Provider Details

I. General information

NPI: 1124027750
Provider Name (Legal Business Name): IRA LOUIS SALOM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 CROSS BRONX EXPY
BRONX NY
10460-4885
US

IV. Provider business mailing address

979 CROSS BRONX EXPY
BRONX NY
10460-4885
US

V. Phone/Fax

Practice location:
  • Phone: 718-665-6490
  • Fax: 718-764-6490
Mailing address:
  • Phone: 718-665-6490
  • Fax: 718-764-6490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number134798
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number134798
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number134798
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: