Provider Demographics
NPI:1669498218
Name:PHILIP M SCADUTO MD PATRICIA M RENZ MD PC
Entity Type:Organization
Organization Name:PHILIP M SCADUTO MD PATRICIA M RENZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SCADUTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-335-8656
Mailing Address - Street 1:223 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005
Mailing Address - Country:US
Mailing Address - Phone:973-335-8656
Mailing Address - Fax:973-335-8986
Practice Address - Street 1:223 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005
Practice Address - Country:US
Practice Address - Phone:973-335-8656
Practice Address - Fax:973-335-8986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
050330Medicare ID - Type Unspecified