1598944936 NPI number — DAVID A SCALZO D.P.M.,P.C.

Table of content: (NPI 1598944936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598944936 NPI number — DAVID A SCALZO D.P.M.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID A SCALZO D.P.M.,P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598944936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 FOOTE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURYEA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18642-1408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-457-4560
Provider Business Mailing Address Fax Number:
570-457-4562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 FOOTE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURYEA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18642-1408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-457-4560
Provider Business Practice Location Address Fax Number:
570-457-4562
Provider Enumeration Date:
11/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCALZO
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
570-457-4560

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  SC004196L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: SC004196L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 002138536 . This is a "PENNSYLVANIA BLUE SHEILD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1021229540001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5386 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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