Provider Demographics
NPI:1790975522
Name:NEAL A. SCKOLNICK, M.D., P.C.
Entity Type:Organization
Organization Name:NEAL A. SCKOLNICK, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCKOLNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-678-2222
Mailing Address - Street 1:30 HEMPSTEAD AVE
Mailing Address - Street 2:SUITE #145
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4033
Mailing Address - Country:US
Mailing Address - Phone:516-678-2222
Mailing Address - Fax:516-764-1259
Practice Address - Street 1:30 HEMPSTEAD AVE
Practice Address - Street 2:SUITE #145
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4033
Practice Address - Country:US
Practice Address - Phone:516-678-2222
Practice Address - Fax:516-764-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00425425Medicaid
NY11A001OtherMEDICARE ID #
NY00425425Medicaid