Provider Demographics
NPI:1881030153
Name:SALZILLO, JOSEPH ANTHONY (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:SALZILLO
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 BOSTON POST RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3537
Mailing Address - Country:US
Mailing Address - Phone:203-876-7533
Mailing Address - Fax:
Practice Address - Street 1:849 BOSTON POST RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3537
Practice Address - Country:US
Practice Address - Phone:203-876-7533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002894363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant