Provider Demographics
NPI:1194822882
Name:MILAZZO, LORRAINE M (MS ATC)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:M
Last Name:MILAZZO
Suffix:
Gender:F
Credentials:MS ATC
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:M
Other - Last Name:SZOCIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS ATC
Mailing Address - Street 1:165 FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963-1246
Mailing Address - Country:US
Mailing Address - Phone:631-899-3297
Mailing Address - Fax:631-725-2313
Practice Address - Street 1:141 NARROW LN
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-3050
Practice Address - Country:US
Practice Address - Phone:631-591-4614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000452-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY22OtherATHLETIC TRAINER