Provider Demographics
NPI:1750382818
Name:SCOOPO, FREDERIC J (MD)
Entity type:Individual
Prefix:
First Name:FREDERIC
Middle Name:J
Last Name:SCOOPO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 SPRINGFIELD AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-4055
Practice Address - Country:US
Practice Address - Phone:908-934-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05375100207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ290008355OtherRAILROAD MEDICARE
NJ77U442OtherEMPIRE HEALTH
NJ5236048OtherAETNA INS.
NJ121630OtherCHN INS.
NJ222233003OtherHORIZON BC
NJ22223300304OtherCIGNA INS.
NJP395982OtherOXFORD INS.
NJ77U442OtherEMPIRE HEALTH
NJP395982OtherOXFORD INS.