Provider Demographics
NPI:1902974819
Name:SCOTTO DI CLEMENTE, MICHAEL JOSEPH (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:SCOTTO DI CLEMENTE
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:373 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3015
Mailing Address - Country:US
Mailing Address - Phone:917-837-8303
Mailing Address - Fax:516-764-2641
Practice Address - Street 1:373 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3015
Practice Address - Country:US
Practice Address - Phone:917-837-8303
Practice Address - Fax:516-764-2641
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYN005032A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01635670Medicaid
NYNPC38824OtherELDERPLAN
NYP411909-P745761OtherOXFORD
NY6200984OtherGHI
NY0005820491OtherAETNA
NY480021593OtherRAILROAD MEDICARE
NYP55512OtherEMPIRE
NY01635670Medicaid