Provider Demographics
NPI:1902315955
Name:SALMON, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:SALMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 ASTOR PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-4204
Mailing Address - Country:US
Mailing Address - Phone:917-952-1467
Mailing Address - Fax:
Practice Address - Street 1:49 ASTOR PL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-4204
Practice Address - Country:US
Practice Address - Phone:917-952-1467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered