Provider Demographics
NPI:1386763910
Name:MILAZZO, SALVATORE (DO)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:
Last Name:MILAZZO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 COOLIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1512
Mailing Address - Country:US
Mailing Address - Phone:908-272-2861
Mailing Address - Fax:
Practice Address - Street 1:2509 PARK AVE
Practice Address - Street 2:SUITE 2D
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5300
Practice Address - Country:US
Practice Address - Phone:908-753-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05013800208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMI501027Medicare ID - Type Unspecified