Provider Demographics
NPI:1609260678
Name:SCOVELL, CHRISTOPHER MATTHEW (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MATTHEW
Last Name:SCOVELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 11TH AVE APT 2701
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-1278
Mailing Address - Country:US
Mailing Address - Phone:419-308-0587
Mailing Address - Fax:
Practice Address - Street 1:211 ESSEX ST STE 204
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3245
Practice Address - Country:US
Practice Address - Phone:201-487-1240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB108526002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry