Provider Demographics
NPI:1508069733
Name:CAVAGNUOLO, SCOTT LOUIS (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LOUIS
Last Name:CAVAGNUOLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 OYSTER BAY RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:11732
Mailing Address - Country:US
Mailing Address - Phone:516-922-8181
Mailing Address - Fax:516-922-8183
Practice Address - Street 1:914 OYSTER BAY RD
Practice Address - Street 2:
Practice Address - City:EAST NORWICH
Practice Address - State:NY
Practice Address - Zip Code:11732
Practice Address - Country:US
Practice Address - Phone:516-922-8181
Practice Address - Fax:516-922-8183
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX6F901Medicare PIN
U96097Medicare UPIN