Provider Demographics
NPI:1508910720
Name:SCACCIO, JEFFREY A (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:SCACCIO
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 1:944 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-2120
Mailing Address - Country:US
Mailing Address - Phone:631-281-5116
Mailing Address - Fax:631-281-5165
Practice Address - Street 1:944 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2120
Practice Address - Country:US
Practice Address - Phone:631-281-5116
Practice Address - Fax:631-281-5165
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX13062Medicare ID - Type Unspecified