Provider Demographics
NPI:1790562049
Name:SCOTT STREATER MD PC
Entity Type:Organization
Organization Name:SCOTT STREATER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:STREATER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-813-8398
Mailing Address - Street 1:239 SOUTHDOWN RD
Mailing Address - Street 2:
Mailing Address - City:LLOYD HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1722
Mailing Address - Country:US
Mailing Address - Phone:631-813-8393
Mailing Address - Fax:
Practice Address - Street 1:13 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2680
Practice Address - Country:US
Practice Address - Phone:631-350-6077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric AnesthesiologyGroup - Multi-Specialty