Provider Demographics
NPI:1518049857
Name:DONG, SCOTT C (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:C
Last Name:DONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-6825
Mailing Address - Country:US
Mailing Address - Phone:212-966-8288
Mailing Address - Fax:212-431-8177
Practice Address - Street 1:38 E BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-6825
Practice Address - Country:US
Practice Address - Phone:212-966-8288
Practice Address - Fax:212-431-8177
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT-004990-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01824822Medicaid