Provider Demographics
NPI:1023100203
Name:DUNZIK, SCOTT DENNIS (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:DENNIS
Last Name:DUNZIK
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 1:29 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1305
Mailing Address - Country:US
Mailing Address - Phone:215-487-4000
Mailing Address - Fax:
Practice Address - Street 1:561 FAIRTHORNE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2412
Practice Address - Country:US
Practice Address - Phone:215-487-4032
Practice Address - Fax:215-483-8187
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA077764002084P0800X
PAMD054346L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001500586Medicaid
PAF90397Medicare UPIN
PA001500586Medicaid