Basic Information
| Provider Information | |||||||||
| NPI: | 1689819534 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALENGA | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | BOLANAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8773 PERIMETER PARK CT | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322161165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044933390 | ||||||||
| FaxNumber: | 9044933395 | ||||||||
| Practice Location | |||||||||
| Address1: | 8773 PERIMETER PARK CT | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322161165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044933390 | ||||||||
| FaxNumber: | 9044933395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2008 | ||||||||
| LastUpdateDate: | 08/04/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 261577 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | ME114390 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | ME114390 | FL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 003174381A | 01 | GA | GEORGIA MEDICAID | OTHER | P01202783 | 01 | FL | RR MEDICARE | OTHER | 14P3S | 01 | FL | FLORIDA BLUE | OTHER | 45681 | 01 | FL | MEDICARE - GROUP | OTHER | 786594 | 01 | FL | WELLCARE | OTHER | 0083955-00 | 05 | FL | MEDICAID | 2610299-00 | 01 | FL | MEDICAID GROUP | OTHER | 363224 | 01 | FL | AVMED | OTHER | GY389Z | 01 | FL | MEDICARE - INDIVIDUAL | OTHER |