Provider Demographics
NPI:1356497309
Name:LIFF, SCOTT DAVID
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:DAVID
Last Name:LIFF
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 1:521 W 135TH ST
Mailing Address - Street 2:APARTMENT NO. 5A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-8433
Mailing Address - Country:US
Mailing Address - Phone:845-661-8002
Mailing Address - Fax:
Practice Address - Street 1:30 E 20TH ST
Practice Address - Street 2:SUITE 5F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1310
Practice Address - Country:US
Practice Address - Phone:845-661-8002
Practice Address - Fax:845-628-2777
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0775971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300080870Medicare PIN