Provider Demographics
NPI:1396774089
Name:ABBRUZZESE, SALVATORE R JR (DO PC)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:R
Last Name:ABBRUZZESE
Suffix:JR
Gender:M
Credentials:DO PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO 00781207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00A0252583OtherHMSA EAST
HI00B0252581OtherHMSA WEST
HI523979Medicaid
RIDO00781OtherMEDICAL LICENSE
HI523979Medicaid