Provider Demographics
NPI:1447351036
Name:SALCEDO, THERESA JOSUE (MD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:JOSUE
Last Name:SALCEDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:THERESA
Other - Middle Name:J
Other - Last Name:SALCEDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9 PROFESSIONAL CIR STE 107
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2427
Mailing Address - Country:US
Mailing Address - Phone:732-462-7614
Mailing Address - Fax:732-462-2822
Practice Address - Street 1:9 PROFESSIONAL CIR STE 107
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2427
Practice Address - Country:US
Practice Address - Phone:732-462-7511
Practice Address - Fax:732-462-2822
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA068615208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics