| Salus Med Pc | |
|
121 Cedar Ln Suite2b Teaneck NJ 07666-4457 | |
| (732) 485-6874 | |
| Not Available |
| Full Name | Salus Med Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 121 Cedar Ln, Teaneck, New Jersey |
| Authorized Official Name and Position | Raymond Manzano Villongco (CEO) |
| Authorized Official Contact | 7323291257 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Salus Med Pc 7 Tanner Dr Princeton NJ 08540-9488 Ph: (732) 329-1257 | Salus Med Pc 121 Cedar Ln Suite2b Teaneck NJ 07666-4457 Ph: (732) 485-6874 |
| NPI Number | 1073652210 |
|---|---|
| Provider Enumeration Date | 02/05/2007 |
| Last Update Date | 01/04/2013 |
| Medicare PECOS PAC ID | 5799872974 |
|---|---|
| Medicare Enrollment ID | O20071105000413 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073652210 | NPI | - | NPPES |
| 01722150 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 25MA07738300 (New Jersey) | Primary |
| 207RG0300X | Internal Medicine - Geriatric Medicine | 25MA07738300 (New Jersey) | Secondary |
| Provider Name | Raymond M Villongco |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962420281 PECOS PAC ID: 2769573963 Enrollment ID: I20070802000052 |
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