Basic Information
| Provider Information | |||||||||
| NPI: | 1033558762 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALTERS | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 25707 149TH RD | ||||||||
| Address2: | |||||||||
| City: | ROSEDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114223022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1718527497 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 25707 149TH RD | ||||||||
| Address2: | |||||||||
| City: | ROSEDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114223022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1718527497 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2013 | ||||||||
| LastUpdateDate: | 09/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | 1100187 | NY | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.