Provider Demographics
NPI:1932145174
Name:DI SCALA, RENO G (MD)
Entity Type:Individual
Prefix:DR
First Name:RENO
Middle Name:G
Last Name:DI SCALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 STEINWAY ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1885
Mailing Address - Country:US
Mailing Address - Phone:347-242-2684
Mailing Address - Fax:347-242-2698
Practice Address - Street 1:2202 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1885
Practice Address - Country:US
Practice Address - Phone:347-242-2684
Practice Address - Fax:347-242-2698
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01721773Medicaid
NY01721773Medicaid
NY01HCBNMedicare ID - Type Unspecified