MEDICARE: SENIOR HEALTHCARE OUTREACH PROGRAM

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
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician		NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588707954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR HEALTHCARE OUTREACH PROGRAM

Provider Business Mailing Address
First Line	:	523 PARK AVE
Second Line	:
City	:	ORANGE
State	:	NJ
Zip	:	07050-1703
Country	:	US
Telephone Number	:	973-556-0955
Fax Number	:	973-675-0040

Provider Business Practice Location Address
First Line	:	613 PARK AVE FL 1
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07017-1905
Country	:	US
Telephone Number	:	973-556-0955
Fax Number	:	973-675-0040

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALEXANDER G SALERNO
Credential	:	MD
Telephone Number	:	973-672-8573

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	03/31/2025

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