Provider Demographics
NPI:1346236668
Name:SCANNAPIEGO, SAVEREN
Entity Type:Individual
Prefix:DR
First Name:SAVEREN
Middle Name:
Last Name:SCANNAPIEGO
Suffix:
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 1:230 W JERSEY ST
Mailing Address - Street 2:STE 201
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1364
Mailing Address - Country:US
Mailing Address - Phone:908-289-1166
Mailing Address - Fax:908-352-4752
Practice Address - Street 1:230 W JERSEY ST
Practice Address - Street 2:STE 201
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1364
Practice Address - Country:US
Practice Address - Phone:908-289-1166
Practice Address - Fax:908-352-4752
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA28346207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0775002Medicaid
NJ526583BKZMedicare UPIN
NJ0775002Medicaid
NJ526583A7AMedicare PIN