Provider Demographics
NPI:1952726325
Name:MILAZZO, JEANINE
Entity Type:Individual
Prefix:MRS
First Name:JEANINE
Middle Name:
Last Name:MILAZZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 THORNYCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-5626
Mailing Address - Country:US
Mailing Address - Phone:718-554-4918
Mailing Address - Fax:
Practice Address - Street 1:282 THORNYCROFT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5626
Practice Address - Country:US
Practice Address - Phone:718-554-4918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency