MEDICARE: MRS. AVIVA BAILA SALOMON RPA-C

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	363A00000X	Physician Assistant	012439	NY

General Provider Information

NPI Number	:	1376715342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AVIVA BAILA SALOMON RPA-C

Provider Business Mailing Address
First Line	:	4901 14TH AVE
Second Line	:	#4D
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3150
Country	:	US
Telephone Number	:	718-436-1827
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 14TH AVE
Second Line	:	#4D
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3150
Country	:	US
Telephone Number	:	718-436-1827
Fax Number	:

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

Provider Enumeration Date	:	03/30/2008
Last Update Date	:	03/30/2008

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