Provider Demographics
NPI:1407464399
Name:NEW SCOTLAND MEDICAL PC
Entity Type:Organization
Organization Name:NEW SCOTLAND MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YASHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ETTEKAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-720-3828
Mailing Address - Street 1:1399 NEW SCOTLAND RD UNIT 124
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-4206
Mailing Address - Country:US
Mailing Address - Phone:310-720-3828
Mailing Address - Fax:
Practice Address - Street 1:1596 ROUTE 9
Practice Address - Street 2:
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-4303
Practice Address - Country:US
Practice Address - Phone:518-371-6772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty