Provider Demographics
NPI:1891760401
Name:SCAGGS, CLIFTON G (DPM)
Entity Type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:G
Last Name:SCAGGS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 WHITE PLAINS RD
Mailing Address - Street 2:SUITE 26
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5063
Mailing Address - Country:US
Mailing Address - Phone:914-472-3030
Mailing Address - Fax:914-472-5575
Practice Address - Street 1:700 WHITE PLAINS RD
Practice Address - Street 2:SUITE 26
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5063
Practice Address - Country:US
Practice Address - Phone:914-472-3030
Practice Address - Fax:914-472-5575
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-18
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2623213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWS1352OtherOXFORD ID
NYT50830Medicare ID - Type UnspecifiedMEDICARE ID
NYP29731Medicare UPIN