Provider Demographics
NPI:1073590741
Name:SCUDERO, GREGG RONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:RONALD
Last Name:SCUDERO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5912 FLATLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-1808
Mailing Address - Country:US
Mailing Address - Phone:718-444-8500
Mailing Address - Fax:718-444-8505
Practice Address - Street 1:5912 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-1808
Practice Address - Country:US
Practice Address - Phone:718-444-8500
Practice Address - Fax:718-444-8505
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0069801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
C069809WOtherWORKERS COMP
U11978Medicare UPIN
X20921Medicare ID - Type Unspecified