Provider Demographics
NPI:1679866115
Name:SALERNO, PEI JUAN (MD)
Entity type:Individual
Prefix:DR
First Name:PEI JUAN
Middle Name:
Last Name:SALERNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PEI JUAN
Other - Middle Name:
Other - Last Name:LEI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:240 INDIAN RIVER RD
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3649
Mailing Address - Country:US
Mailing Address - Phone:203-795-6025
Mailing Address - Fax:203-799-1554
Practice Address - Street 1:240 INDIAN RIVER RD
Practice Address - Street 2:SUITE B-1
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3649
Practice Address - Country:US
Practice Address - Phone:203-795-6025
Practice Address - Fax:203-799-1554
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT52972208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008051680Medicaid