Provider Demographics
NPI:1053402438
Name:GAUDINO, SALVATORE (DPM)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:
Last Name:GAUDINO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 74TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2602
Mailing Address - Country:US
Mailing Address - Phone:718-836-1017
Mailing Address - Fax:718-836-9555
Practice Address - Street 1:420 74TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2602
Practice Address - Country:US
Practice Address - Phone:718-836-1017
Practice Address - Fax:718-836-9555
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005093213EP1101X, 213ES0131X
NJ02607213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01803956Medicaid
NYP23721Medicare PIN
NY01803956Medicaid
NYU59824Medicare UPIN