Provider Demographics
NPI:1578624623
Name:SCARSDALE MEDICAL GROUP LLP
Entity Type:Organization
Organization Name:SCARSDALE MEDICAL GROUP LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-723-8100
Mailing Address - Street 1:259 HEATHCOTE RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4523
Mailing Address - Country:US
Mailing Address - Phone:914-723-8100
Mailing Address - Fax:914-219-1985
Practice Address - Street 1:259 HEATHCOTE RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4523
Practice Address - Country:US
Practice Address - Phone:914-723-8100
Practice Address - Fax:914-219-1985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
NY188962207RC0000X
NY77180207RE0101X
NY112529207RG0100X
NY212064207RG0100X
NY120660207RH0003X
NY154694207RI0200X
NY146776207RI0200X
NY173181207RI0200X
NY220722207RI0200X
NY141849207RP1001X
NY195702207RP1001X
NY137782207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Not Answered207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Not Answered207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Not Answered207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1578624623Medicare NSC