Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 044281 | NY |
NPI | 1144423633 |
---|---|
Provider Name | Dr. Matthew P Salvatore |
First Address | Camillus, NY 13031 |
Second Address | Camillus, NY 13031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 08/07/2007 |