Provider Demographics
NPI:1619500063
Name:MILAZZO, SALVATORE JOSEPH (PA-C)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:JOSEPH
Last Name:MILAZZO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-3822
Mailing Address - Country:US
Mailing Address - Phone:646-938-7336
Mailing Address - Fax:
Practice Address - Street 1:1 W 125TH ST FRNT 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4524
Practice Address - Country:US
Practice Address - Phone:212-265-2500
Practice Address - Fax:646-952-0260
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1171311363A00000X
NY024822363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant