Provider Demographics
NPI:1982007654
Name:SCOMA MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:SCOMA MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-746-2212
Mailing Address - Street 1:173 MINEOLA BLVD
Mailing Address - Street 2:SUITE 401A
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2528
Mailing Address - Country:US
Mailing Address - Phone:516-746-2212
Mailing Address - Fax:516-746-3231
Practice Address - Street 1:173 MINEOLA BLVD
Practice Address - Street 2:SUITE 401A
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2528
Practice Address - Country:US
Practice Address - Phone:516-746-2212
Practice Address - Fax:516-746-3231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty