MEDICARE: IRA LOUIS SALOM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	134798	NY
2	208U00000X	Clinical Pharmacology Physician	134798	NY
3	207R00000X	Internal Medicine Physician	134798	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25MA08564600	OTHER	NJ	NEW JERSEY LICENSE
2	134798	OTHER	NY	NY MEDICAL LICENSE

General Provider Information

NPI Number	:	1124027750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRA LOUIS SALOM MD

Provider Business Mailing Address
First Line	:	979 CROSS BRONX EXPY
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10460-4885
Country	:	US
Telephone Number	:	718-665-6490
Fax Number	:	718-764-6490

Provider Business Practice Location Address
First Line	:	979 CROSS BRONX EXPY
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10460-4885
Country	:	US
Telephone Number	:	718-665-6490
Fax Number	:	718-764-6490

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	04/07/2025

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Directions to “ IRA LOUIS SALOM MD” Practice Location

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