Provider Demographics
NPI:1558400077
Name:ALTMAN, SCOTT
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:ALTMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 E 61ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8558
Mailing Address - Country:US
Mailing Address - Phone:212-838-6737
Mailing Address - Fax:212-486-9078
Practice Address - Street 1:252 E 61ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8558
Practice Address - Country:US
Practice Address - Phone:212-838-6737
Practice Address - Fax:212-486-9078
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003062-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3599691OtherOXFORD
NY4353787OtherAETNA
NY1432909OtherUNITED HEALTHCARE
NYP35161Medicare ID - Type Unspecified
NY1432909OtherUNITED HEALTHCARE