Provider Demographics
NPI:1124041819
Name:HERBERT, SCOTT EVAN (DPM)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:EVAN
Last Name:HERBERT
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 1:33 N OCEAN AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3049
Mailing Address - Country:US
Mailing Address - Phone:516-378-0184
Mailing Address - Fax:516-378-0294
Practice Address - Street 1:33 N OCEAN AVE STE 4
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3049
Practice Address - Country:US
Practice Address - Phone:516-378-0184
Practice Address - Fax:516-378-0294
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO6079213E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPJ9761Medicare ID - Type Unspecified
NYV05415Medicare UPIN
5653570001Medicare NSC