Provider Demographics
NPI:1164563839
Name:SCOLLO, PAUL (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:SCOLLO
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 1:32 JORGENSEN LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-1216
Mailing Address - Country:US
Mailing Address - Phone:973-227-8596
Mailing Address - Fax:973-227-8597
Practice Address - Street 1:32 JORGENSEN LN
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-1216
Practice Address - Country:US
Practice Address - Phone:973-227-8596
Practice Address - Fax:973-227-8597
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00116700213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0401609Medicaid
NJT73078Medicare UPIN
NJ0401609Medicaid
NJ4566270001Medicare NSC