Provider Demographics
NPI:1073622684
Name:RABOY, SCOTT M (DPM)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:RABOY
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 1:1081 PAULISON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-3627
Mailing Address - Country:US
Mailing Address - Phone:973-340-1400
Mailing Address - Fax:973-340-7470
Practice Address - Street 1:1081 PAULISON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-3627
Practice Address - Country:US
Practice Address - Phone:973-340-1400
Practice Address - Fax:973-340-7470
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00188500213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0446761000OtherAMERIHEALTH
NJ480028342OtherPALMETTO GBA RAILROAD MED
NJ86986OtherAMERIGROUP
F03338OtherCARECORE
NJ0138844OtherGHI
NJHUL000204OtherAMERICHOICE
NJHUL000204OtherAMERICHOICE
F03338OtherCARECORE