Basic Information
| Provider Information | |||||||||
| NPI: | 1508829706 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALERNO | ||||||||
| FirstName: | LAURIE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | A.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1395 NW 167TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331695710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575339441 | ||||||||
| FaxNumber: | 7574461454 | ||||||||
| Practice Location | |||||||||
| Address1: | 549 E BRAMBLETON AVE | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235102905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575339441 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 03/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | F302915-1 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | 0024171474 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 00026496401 | 01 | NJ | UNIVERA | OTHER | 02154694 | 05 | NM | MEDICAID | 166192295 | 01 | NJ | GHI | OTHER | 166192295 | 01 | NY | EMPIRE | OTHER | 500019800 | 01 | NY | RAILROAD MEDICARE | OTHER | 000560568001 | 01 | NY | BLUE CROSS | OTHER | 9512165 | 01 | NJ | INDEPENDENT HEALTH | OTHER | 000560568001 | 01 | NY | COMMUNITY BLUE | OTHER |