Provider Demographics
NPI:1356420715
Name:SKOPE MEDICAL CARE P.C.
Entity type:Organization
Organization Name:SKOPE MEDICAL CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DATA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGJOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-253-0270
Mailing Address - Street 1:1537 STRAIGHT PATH
Mailing Address - Street 2:STE 102
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11798-3414
Mailing Address - Country:US
Mailing Address - Phone:631-253-0270
Mailing Address - Fax:
Practice Address - Street 1:1537 STRAIGHT PATH
Practice Address - Street 2:STE 102
Practice Address - City:WYANDANCH
Practice Address - State:NY
Practice Address - Zip Code:11798-3414
Practice Address - Country:US
Practice Address - Phone:631-253-0270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211159207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01889129Medicaid
NYWEP651Medicare ID - Type Unspecified