Provider Demographics
NPI:1255656567
Name:BUDA, SCOTT I
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:BUDA
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5419
Mailing Address - Country:US
Mailing Address - Phone:516-377-4050
Mailing Address - Fax:516-378-1809
Practice Address - Street 1:179 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-4922
Practice Address - Country:US
Practice Address - Phone:516-377-4050
Practice Address - Fax:516-378-1809
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist