Healthcare Provider Details

I. General information

NPI: 1164406229
Provider Name (Legal Business Name): PAUL D SALZBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9741 ST RT 97
CALLICOON NY
12723-0899
US

IV. Provider business mailing address

PO BOX 899
CALLICOON NY
12723-0899
US

V. Phone/Fax

Practice location:
  • Phone: 845-887-6112
  • Fax: 845-887-6245
Mailing address:
  • Phone: 845-887-6112
  • Fax: 845-887-6245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number155001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: