Provider Demographics
NPI:1184733958
Name:SCOTTO, MICHAEL (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SCOTTO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 MANOR RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2958
Mailing Address - Country:US
Mailing Address - Phone:718-816-8634
Mailing Address - Fax:718-816-8664
Practice Address - Street 1:372 MANOR RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-2958
Practice Address - Country:US
Practice Address - Phone:718-816-8634
Practice Address - Fax:718-816-8664
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005621213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03335595Medicaid
NY02000333Medicaid
NY2000159000004OtherCIGNA
NYPB2881Medicare PIN
NY02000333Medicaid
NY4771900001Medicare NSC
NYA400024225Medicare PIN
NY03335595Medicaid
NYA100024224Medicare PIN