Provider Demographics
NPI:1700459807
Name:SOLTIS, SCOTT G
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:G
Last Name:SOLTIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 MAIN ST STE 100-289
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1846
Mailing Address - Country:US
Mailing Address - Phone:732-640-5551
Mailing Address - Fax:
Practice Address - Street 1:9 E GATE DR
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07418-2007
Practice Address - Country:US
Practice Address - Phone:732-640-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC0840726171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor