Provider Demographics
NPI:1447224175
Name:FOXMAN, SCOTT G (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:G
Last Name:FOXMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 TILTON RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1827
Mailing Address - Country:US
Mailing Address - Phone:609-646-5200
Mailing Address - Fax:609-646-9868
Practice Address - Street 1:1500 TILTON RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1827
Practice Address - Country:US
Practice Address - Phone:609-646-5200
Practice Address - Fax:609-646-9868
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033690E207W00000X
NJ25MA04698800207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2198207Medicaid
NJFO460251Medicare ID - Type Unspecified
NJ2198207Medicaid
NJFO 460251Medicare PIN