Basic Information
Provider Information
NPI: 1033558762
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SALTERS
FirstName: LISA
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171M00000X1100187NYY Other Service ProvidersCase Manager/Care Coordinator 

No ID Information.


Home