Healthcare Provider Details

I. General information

NPI: 1750869673
Provider Name (Legal Business Name): ANTHONY JOSEPH SALVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MULBERRY ST
SCRANTON PA
18503-1225
US

IV. Provider business mailing address

608 HICKORY ST
PECKVILLE PA
18452-2218
US

V. Phone/Fax

Practice location:
  • Phone: 570-955-5479
  • Fax:
Mailing address:
  • Phone: 272-207-8570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW135398
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: