Healthcare Provider Details

I. General information

NPI: 1023062973
Provider Name (Legal Business Name): JOANN N SALVEMINI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 STONY BROOK RD STE 200
STONY BROOK NY
11790
US

IV. Provider business mailing address

825 NORTHERN BLVD STE 300
GREAT NECK NY
11021-5323
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-4200
  • Fax: 631-444-4276
Mailing address:
  • Phone: 516-773-4500
  • Fax: 516-773-9896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number190339
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: