1356515597 NPI number — TIFFANY LYNN SCOTT M.D.

Table of content: TIFFANY LYNN SCOTT M.D. (NPI 1356515597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356515597 NPI number — TIFFANY LYNN SCOTT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCOTT
Provider First Name:
TIFFANY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEWTON
Provider Other First Name:
TIFFANY
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356515597
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3325 N. ARLINGTON HEIGHTS ROAD
Provider Second Line Business Mailing Address:
SUITE 100A
Provider Business Mailing Address City Name:
ARLINGTON HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-398-0400
Provider Business Mailing Address Fax Number:
847-398-9590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
76 STIRLING RD.
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-755-5437
Provider Business Practice Location Address Fax Number:
908-755-6905
Provider Enumeration Date:
04/18/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  2011-00207 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 36-134855 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)