Provider Demographics
NPI:1568469757
Name:TRAZZERA, SALVATORE (MD)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:
Last Name:TRAZZERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 FALLWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-4929
Mailing Address - Country:US
Mailing Address - Phone:516-249-1020
Mailing Address - Fax:516-249-1305
Practice Address - Street 1:206 FALLWOOD PKWY
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-4929
Practice Address - Country:US
Practice Address - Phone:516-249-1020
Practice Address - Fax:516-249-1305
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187894207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01836777Medicaid
NY01836777Medicaid
NYG39647Medicare UPIN