Provider Demographics
NPI:1831200104
Name:GALLUZZO, SALVATORE J (DPM)
Entity type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:J
Last Name:GALLUZZO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 ROUTE 146
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3614
Mailing Address - Country:US
Mailing Address - Phone:518-383-0302
Mailing Address - Fax:518-373-2298
Practice Address - Street 1:954 ROUTE 146
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3614
Practice Address - Country:US
Practice Address - Phone:518-383-0302
Practice Address - Fax:518-373-2298
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0040891213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
10000728OtherCDPHP HMO
NY01520763Medicaid
NYJ300035656Medicare PIN
NY01520763Medicaid
T92206Medicare UPIN