Provider Demographics
NPI:1639262314
Name:SCALICI, PETER P (DPM)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:P
Last Name:SCALICI
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 1:4 COUGHLAN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-3122
Mailing Address - Country:US
Mailing Address - Phone:718-273-1451
Mailing Address - Fax:718-273-1451
Practice Address - Street 1:4 COUGHLAN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-3122
Practice Address - Country:US
Practice Address - Phone:718-273-1451
Practice Address - Fax:718-273-1451
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002444208600000X
NYN004168213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T51468Medicare UPIN
P45861Medicare PIN