1235953522 NPI number — MATTHIAS A SCOTT LMT, MMP, COMT

Table of content: MATTHIAS A SCOTT LMT, MMP, COMT (NPI 1235953522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235953522 NPI number — MATTHIAS A SCOTT LMT, MMP, COMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCOTT
Provider First Name:
MATTHIAS
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMT, MMP, COMT
Provider Gender Code:
M

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:
1235953522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 LLOYD CT APT 2B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NUTLEY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07110-2367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-931-5803
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 OUTWATER LN
Provider Second Line Business Practice Location Address:
2ND FL
Provider Business Practice Location Address City Name:
GARFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07026-3854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-371-1125
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2024

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: 225700000X , with the licence number:  18KT00839000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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