Provider Demographics
NPI:1245937168
Name:DEOCAMPO, SALVADOR DELARIARTE
Entity type:Individual
Prefix:
First Name:SALVADOR
Middle Name:DELARIARTE
Last Name:DEOCAMPO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7939 CALAMUS AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4165
Mailing Address - Country:US
Mailing Address - Phone:347-268-1299
Mailing Address - Fax:
Practice Address - Street 1:7939 CALAMUS AVE APT 1B
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4165
Practice Address - Country:US
Practice Address - Phone:347-268-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-10
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY029243OtherPT LICENCE