# BLACK CREEK MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134883143
- **Authorized official:** JOHN SALERNO MD (OWNER)
- **Authorized official phone:** (914) 376-6100

## Contact information

- **Practice address:** 46 N CENTRAL AVE, RAMSEY, NJ 07446-1864
- **Practice address phone:** (914) 376-6100
- **Practice address fax:** (914) 470-5056
- **Mailing address:** PO BOX 648, MILFORD, DE 19963-0648
- **Mailing address phone:** (914) 376-6100
- **Mailing address fax:** (914) 470-5056

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/26/2021
- **Last updated:** 10/26/2021