Provider Demographics
NPI:1598795387
Name:SCOTTO DIMINICO, MARY (DC DOCTOR OF CHIROPO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:SCOTTO DIMINICO
Suffix:
Gender:F
Credentials:DC DOCTOR OF CHIROPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 EAST 38TH STREET
Mailing Address - Street 2:SUITE 2K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-687-5438
Mailing Address - Fax:212-687-5434
Practice Address - Street 1:155 EAST 38TH STREET
Practice Address - Street 2:SUITE 2K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-687-5438
Practice Address - Fax:212-687-5434
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U93368Medicare UPIN
NYX5P671Medicare ID - Type Unspecified