Healthcare Provider Details

I. General information

NPI: 1215371679
Provider Name (Legal Business Name): ABHIJIT LAU SALASKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2013
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

224 HARRISON ST STE 601
SYRACUSE NY
13202-3058
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5189
  • Fax: 315-464-7494
Mailing address:
  • Phone: 315-464-5660
  • Fax: 315-464-7695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number24357
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number331358
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number24357
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number331358
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: