Healthcare Provider Details

I. General information

NPI: 1245575760
Provider Name (Legal Business Name): SALUD MEDICAL OFFICE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2088 AMSTERDAM AVE 2ND FLOOR
NEW YORK NY
10032-5015
US

IV. Provider business mailing address

2088 AMSTERDAM AVE 2ND FLOOR
NEW YORK NY
10032-5015
US

V. Phone/Fax

Practice location:
  • Phone: 212-928-1125
  • Fax: 212-928-1144
Mailing address:
  • Phone: 212-928-1125
  • Fax: 212-928-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number118487
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: FRED A AVILA
Title or Position: PRESIDENT
Credential: MD
Phone: 212-928-1125