Provider Demographics
NPI:1750521019
Name:DUONG, SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:DUONG
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 1:10 NEVADA DRIVE
Mailing Address - Street 2:NORTH SHORE LIJ LABORATORIES
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:516-224-8505
Mailing Address - Fax:516-719-1254
Practice Address - Street 1:10 NEVADA DRIVE
Practice Address - Street 2:NORTH SHORE LIJ LABORATORIES
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-224-8505
Practice Address - Fax:516-719-1254
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215016207ZC0006X
NY256263207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology