Provider Demographics
NPI:1598080731
Name:MICHAEL SCOTTO DPM PLLC
Entity Type:Organization
Organization Name:MICHAEL SCOTTO DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-816-8634
Mailing Address - Street 1:376 MANOR RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2958
Mailing Address - Country:US
Mailing Address - Phone:718-816-8634
Mailing Address - Fax:718-815-2186
Practice Address - Street 1:376 MANOR RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-2958
Practice Address - Country:US
Practice Address - Phone:718-816-8634
Practice Address - Fax:718-815-2186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005621-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02000333Medicaid