Healthcare Provider Details

I. General information

NPI: 1831445931
Provider Name (Legal Business Name): THERESA SALERNO FNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CHARLES ST
NEW YORK NY
10014-6122
US

IV. Provider business mailing address

101 CHARLES ST 5RE
NEW YORK NY
10014
US

V. Phone/Fax

Practice location:
  • Phone: 732-939-3210
  • Fax:
Mailing address:
  • Phone: 732-939-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number337179
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: