Provider Demographics
NPI:1629326244
Name:DR GARY SCARDINO
Entity Type:Organization
Organization Name:DR GARY SCARDINO
Other - Org Name:SCARDINO FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SCARDINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-860-7275
Mailing Address - Street 1:319 SOUTH STATE STREET
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1929
Mailing Address - Country:US
Mailing Address - Phone:215-860-7275
Mailing Address - Fax:215-860-6189
Practice Address - Street 1:319 SOUTH STATE STREET F
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1929
Practice Address - Country:US
Practice Address - Phone:215-860-7275
Practice Address - Fax:215-860-6189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR GARY SCARDINO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006909L111N00000X
MD01877111N00000X
NJMC005399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASC020148Medicare PIN