Provider Demographics
NPI:1043246085
Name:GAWLIK, SCOTT C (DPM)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:GAWLIK
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 1:8407 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3401
Mailing Address - Country:US
Mailing Address - Phone:718-921-2156
Mailing Address - Fax:718-921-9536
Practice Address - Street 1:8407 15TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3401
Practice Address - Country:US
Practice Address - Phone:718-921-2156
Practice Address - Fax:718-921-9536
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005585213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01977944Medicaid
NY01977944Medicaid
NYPB0911Medicare PIN