Provider Demographics
NPI:1619962586
Name:IPPOLITO, SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:IPPOLITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HEALTHY WAY
Mailing Address - Street 2:ATTN: PHYSICIAN BILLING
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1551
Mailing Address - Country:US
Mailing Address - Phone:516-255-8400
Mailing Address - Fax:516-255-4672
Practice Address - Street 1:196 MERRICK RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1420
Practice Address - Country:US
Practice Address - Phone:516-255-8400
Practice Address - Fax:516-255-8453
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY179201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000059757OtherGHI HMO
NY050710000017OtherFIDELIS
NY1000024409OtherAFFINITY
NY113565450OtherGREAT WEST
NY01729560Medicaid
NY113565450OtherFIRST HEALTH
NY2984981OtherAETNA HMO
NYAA71641OtherMDNY
NY0D4541OtherBCBS
NY113565450OtherMAGNACARE
NY5998030OtherGHI PPO
NYP2214590OtherOXFORD
NY179201OtherHIP
NM2C9258OtherHEALTHNET
NY4278367OtherAETNA PPO
NYBEECH STREETOther113565450
NYCIGNAOther5874507
NMMULTIPLANOther113565450
NYAA71641OtherMDNY
NY60F77AA581Medicare PIN