Provider Demographics
NPI:1932119732
Name:PELCYGER, SCOTT M (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:PELCYGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BARTHOLDI AVE
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-1402
Mailing Address - Country:US
Mailing Address - Phone:973-838-1096
Mailing Address - Fax:973-838-1768
Practice Address - Street 1:6 BARTHOLDI AVE
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:NJ
Practice Address - Zip Code:07405-1402
Practice Address - Country:US
Practice Address - Phone:973-838-1096
Practice Address - Fax:973-838-1768
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2871152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ41032OtherAETNA
NJ222211575OtherFEDERAL TAX ID
NJ4705700Medicaid
NJU26865Medicare UPIN
NJ4705700Medicaid
NJ222211575OtherFEDERAL TAX ID
NJ0697100001Medicare NSC