Provider Demographics
NPI:1629155627
Name:FUGGETTA, DAVID SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SCOTT
Last Name:FUGGETTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9117 157TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-2741
Mailing Address - Country:US
Mailing Address - Phone:718-845-6600
Mailing Address - Fax:718-738-1782
Practice Address - Street 1:9117 157TH AVE
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2741
Practice Address - Country:US
Practice Address - Phone:718-845-6600
Practice Address - Fax:718-738-1782
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009366-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5806185OtherGHI
NY617429OtherUNITED HEALTHCARE
NYP2162430OtherOXFORD HEALTHCARE
NYX0G810OtherBLUECROSS/BLUESHIELD
NYP2162430OtherOXFORD HEALTHCARE
NY617429OtherUNITED HEALTHCARE