Provider Demographics
NPI:1417466699
Name:MILAZZO, KRISTEN ANN
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:ANN
Last Name:MILAZZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CONKLINTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WANAQUE
Mailing Address - State:NJ
Mailing Address - Zip Code:07465-2122
Mailing Address - Country:US
Mailing Address - Phone:973-835-1900
Mailing Address - Fax:973-835-2834
Practice Address - Street 1:205 CONKLINTOWN RD
Practice Address - Street 2:
Practice Address - City:WANAQUE
Practice Address - State:NJ
Practice Address - Zip Code:07465-2122
Practice Address - Country:US
Practice Address - Phone:973-835-1900
Practice Address - Fax:973-835-2834
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty