Healthcare Provider Details

I. General information

NPI: 1881770741
Provider Name (Legal Business Name): MILO FILIPPO VASSALLO M.D./PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CADMAN PLZ W STE 1301
BROOKLYN NY
11201-3229
US

IV. Provider business mailing address

660 WHITE PLAINS RD FL 4
TARRYTOWN NY
10591-5139
US

V. Phone/Fax

Practice location:
  • Phone: 718-208-4449
  • Fax:
Mailing address:
  • Phone: 914-984-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number221951
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number258115
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: