Basic Information
Provider Information | |||||||||
NPI: | 1831241694 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SALZMAN | ||||||||
FirstName: | GREGG | ||||||||
MiddleName: | L | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.C. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 10 TREMBLAY RD | ||||||||
Address2: |   | ||||||||
City: | EAST BRUNSWICK | ||||||||
State: | NJ | ||||||||
PostalCode: | 088164563 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4102186500 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 11301 AMHERST AVE | ||||||||
Address2: | #102 | ||||||||
City: | WHEATON | ||||||||
State: | MD | ||||||||
PostalCode: | 209024665 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3019337827 | ||||||||
FaxNumber: | 2402900342 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/18/2007 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 02168 | MD | Y |   | Chiropractic Providers | Chiropractor |   |
No ID Information.