Provider Demographics
NPI:1295850915
Name:MAGILL, SCOTT RYAN III
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:RYAN
Last Name:MAGILL
Suffix:III
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 1:51 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07462-3510
Mailing Address - Country:US
Mailing Address - Phone:973-543-5656
Mailing Address - Fax:
Practice Address - Street 1:80 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945-1230
Practice Address - Country:US
Practice Address - Phone:973-543-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)