Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 02828 | NJ |
NPI | 1013098565 |
---|---|
Provider Name | Dr. Robert L Salth |
First Address | Stratford, NJ 08084-1324 |
Second Address | Stratford, NJ 08084-1324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 23/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0396401 | (05) | NJ |
U33256 | (02) | NJ |