Provider Demographics
NPI:1790966968
Name:SCOTT REX, MD, LLC.
Entity Type:Organization
Organization Name:SCOTT REX, MD, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:REX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-467-4788
Mailing Address - Street 1:620 PORT WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3714
Mailing Address - Country:US
Mailing Address - Phone:516-467-4788
Mailing Address - Fax:516-467-4793
Practice Address - Street 1:620 PORT WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3714
Practice Address - Country:US
Practice Address - Phone:516-467-4788
Practice Address - Fax:516-467-4793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWZVYW1Medicare PIN