Provider Demographics
NPI:1518077098
Name:SCAVO, SUSAN A (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:SCAVO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 650
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4235
Mailing Address - Country:US
Mailing Address - Phone:516-747-0105
Mailing Address - Fax:516-280-2612
Practice Address - Street 1:200 OLD COUNTRY RD
Practice Address - Street 2:SUITE 650
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4235
Practice Address - Country:US
Practice Address - Phone:516-747-0105
Practice Address - Fax:516-280-2612
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2059971207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2C8532OtherPHS (HEALTHNET)
NY50Z161OtherEMPIRE PLAN
NYP1297217OtherOXFORD
NY010205997NY01OtherANTHEM
NY262689012OtherHORIZON
NY50Z161OtherBLUE CHOICE
NY160048628OtherRR MEDICARE
NY1912086OtherUNITED HEALTHCARE
NY262689012OtherMULTI PLAN
NY5662762OtherAETNA PPO/POS
NYNS0003502OtherSELECT PRO
NY0407961OtherGHI
NY262689012OtherMAGNA CARE
NY5009001003OtherCIGNA
NY71560OtherGHI HMO
NY2185065OtherAETNA HNO
NY50Z161Medicare ID - Type Unspecified
NY5662762OtherAETNA PPO/POS