1164452207 NPI number — DR. ROBERT C SALEK D.P.M.

Table of content: MR. SIDHARTH ANNEBOINA PT (NPI 1659683407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164452207 NPI number — DR. ROBERT C SALEK D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALEK
Provider First Name:
ROBERT
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164452207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FIDEL
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87049-0130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-552-5358
Provider Business Mailing Address Fax Number:
505-552-5805

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80B VETERAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ACOMA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-552-5358
Provider Business Practice Location Address Fax Number:
505-552-5805
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  DPM0000000650 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: H3451 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com