Provider Demographics
NPI:1750415626
Name:GALIMIDI-HODARA, SALOMON (MD)
Entity type:Individual
Prefix:DR
First Name:SALOMON
Middle Name:
Last Name:GALIMIDI-HODARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SALOMON
Other - Middle Name:
Other - Last Name:GALIMIDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:500 N WOOD AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4163
Mailing Address - Country:US
Mailing Address - Phone:908-955-8686
Mailing Address - Fax:908-955-8586
Practice Address - Street 1:500 N WOOD AVE STE 2A
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4163
Practice Address - Country:US
Practice Address - Phone:908-955-8686
Practice Address - Fax:908-955-8685
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25 MA04682200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3280306Medicaid