Provider Demographics
NPI:1013936459
Name:MILAZZO, RAYMOND (DO)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:MILAZZO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GODWIN DR
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-2728
Mailing Address - Country:US
Mailing Address - Phone:201-891-8110
Mailing Address - Fax:201-847-0548
Practice Address - Street 1:1 GODWIN DR
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-2728
Practice Address - Country:US
Practice Address - Phone:201-891-8110
Practice Address - Fax:201-847-0548
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00216200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ099008Medicare UPIN
NJT45269Medicare PIN