Provider Demographics
NPI:1619038791
Name:SALVATORE, WILLIAM VICTOR (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:VICTOR
Last Name:SALVATORE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 LONG BEACH ROAD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572
Mailing Address - Country:US
Mailing Address - Phone:516-766-1717
Mailing Address - Fax:
Practice Address - Street 1:2421 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1320
Practice Address - Country:US
Practice Address - Phone:516-766-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006675-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU56485Medicare UPIN
NYX68601Medicare ID - Type Unspecified