1518077098 NPI number — SUSAN A SCAVO M.D.

Table of content: SUSAN A SCAVO M.D. (NPI 1518077098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518077098 NPI number — SUSAN A SCAVO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCAVO
Provider First Name:
SUSAN
Provider Middle Name:
A
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:
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:
1518077098
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 OLD COUNTRY RD
Provider Second Line Business Mailing Address:
SUITE 650
Provider Business Mailing Address City Name:
MINEOLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11501-4235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-747-0105
Provider Business Mailing Address Fax Number:
516-280-2612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 OLD COUNTRY RD
Provider Second Line Business Practice Location Address:
SUITE 650
Provider Business Practice Location Address City Name:
MINEOLA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11501-4235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-747-0105
Provider Business Practice Location Address Fax Number:
516-280-2612
Provider Enumeration Date:
08/30/2006

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: 207V00000X , with the licence number:  2059971 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2C8532 . This is a "PHS (HEALTHNET)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 50Z161 . This is a "EMPIRE PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1297217 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 010205997NY01 . This is a "ANTHEM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 262689012 . This is a "HORIZON" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 50Z161 . This is a "BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 160048628 . This is a "RR MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1912086 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 262689012 . This is a "MULTI PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5662762 . This is a "AETNA PPO/POS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NS0003502 . This is a "SELECT PRO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0407961 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 262689012 . This is a "MAGNA CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5009001003 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 71560 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2185065 . This is a "AETNA HNO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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