Provider Demographics
NPI:1437107976
Name:SALCEDO, VIVENCIO LEE JR (MD)
Entity type:Individual
Prefix:DR
First Name:VIVENCIO
Middle Name:LEE
Last Name:SALCEDO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:21 CONVERSE LN
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-5101
Mailing Address - Country:US
Mailing Address - Phone:781-665-8517
Mailing Address - Fax:781-665-8517
Practice Address - Street 1:CASTLE POINT RD, ROUTE 9
Practice Address - Street 2:
Practice Address - City:CASTLE POINT
Practice Address - State:NY
Practice Address - Zip Code:12511
Practice Address - Country:US
Practice Address - Phone:845-831-2000
Practice Address - Fax:845-838-5184
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME11618225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner