Provider Demographics
NPI:1720190259
Name:SCEUSA, CARL G (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:G
Last Name:SCEUSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 RICHMOND AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1578
Mailing Address - Country:US
Mailing Address - Phone:718-370-7700
Mailing Address - Fax:718-370-7798
Practice Address - Street 1:1550 RICHMOND AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1578
Practice Address - Country:US
Practice Address - Phone:718-370-7700
Practice Address - Fax:718-370-7798
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170950207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01160883Medicaid
NY1720190259OtherNPI
NY1720190259OtherNPI