MEDICARE: MATTHEW D SALMEN MS, ATC, CSCS

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	2255A2300X	Athletic Trainer	002929-1	NY

General Provider Information

NPI Number	:	1619512688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW D SALMEN MS, ATC, CSCS

Provider Business Mailing Address
First Line	:	23 ROMODA DR
Second Line	:
City	:	CANTON
State	:	NY
Zip	:	13617-1501
Country	:	US
Telephone Number	:	315-229-5835
Fax Number	:	315-229-5414

Provider Business Practice Location Address
First Line	:	23 ROMODA DR
Second Line	:
City	:	CANTON
State	:	NY
Zip	:	13617-1501
Country	:	US
Telephone Number	:	315-229-5835
Fax Number	:	315-229-5414

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

Provider Enumeration Date	:	11/13/2019
Last Update Date	:	11/13/2019

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