Provider Demographics
NPI:1720473424
Name:MICHENER, SCOTT (RN)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:MICHENER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 MANHATTAN AVE
Mailing Address - Street 2:APT 2D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-1048
Mailing Address - Country:US
Mailing Address - Phone:917-767-1136
Mailing Address - Fax:
Practice Address - Street 1:838 PELHAMDALE AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-1032
Practice Address - Country:US
Practice Address - Phone:914-576-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY689463163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice