Provider Demographics
NPI:1689385643
Name:SALVATORE R ABBRUZZESE DO PC
Entity Type:Organization
Organization Name:SALVATORE R ABBRUZZESE DO PC
Other - Org Name:SALVATORE R ABBRUZZESE DO PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ABBRUZZESE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:401-757-6973
Mailing Address - Street 1:10 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3176
Mailing Address - Country:US
Mailing Address - Phone:401-757-6973
Mailing Address - Fax:401-685-0420
Practice Address - Street 1:10 HIGH ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3176
Practice Address - Country:US
Practice Address - Phone:401-757-6973
Practice Address - Fax:401-685-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDO00781OtherMEDICAL LICENSE