Provider Demographics
NPI:1497874036
Name:SALVATORE J. MILAZZO,D.O.,P.A.
Entity type:Organization
Organization Name:SALVATORE J. MILAZZO,D.O.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:908-272-2861
Mailing Address - Street 1:405 COOLIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1512
Mailing Address - Country:US
Mailing Address - Phone:908-272-2861
Mailing Address - Fax:
Practice Address - Street 1:19-21 FAIR LAWN AVE
Practice Address - Street 2:SUITE H
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2331
Practice Address - Country:US
Practice Address - Phone:908-272-2861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05013800208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ090428Medicare ID - Type Unspecified