Provider Demographics
NPI:1114037892
Name:BANKS, SCOTT J (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:J
Last Name:BANKS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:J
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:755 NEW YORK AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4240
Mailing Address - Country:US
Mailing Address - Phone:631-271-0770
Mailing Address - Fax:631-271-0786
Practice Address - Street 1:755 NEW YORK AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4240
Practice Address - Country:US
Practice Address - Phone:631-271-0770
Practice Address - Fax:631-271-0786
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0030521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX1832OtherEMPIRE BC/BS
NYP1640097OtherOXFORD
NY0040687OtherGHI
NY112787682 0005OtherCIGNA
NY4300220OtherAETNA
NY70709OtherUNITED HEALTHCARE
NY70709OtherUNITED HEALTHCARE
NYX1832OtherEMPIRE BC/BS