Provider Demographics
NPI:1548255581
Name:SALAMON, MICHAEL JACOB (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JACOB
Last Name:SALAMON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 BROADWAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1630
Mailing Address - Country:US
Mailing Address - Phone:516-596-0073
Mailing Address - Fax:516-599-5698
Practice Address - Street 1:1728 BROADWAY
Practice Address - Street 2:SUITE 1
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1630
Practice Address - Country:US
Practice Address - Phone:516-596-0073
Practice Address - Fax:516-599-5698
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007842103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV256314Medicare ID - Type Unspecified