Provider Demographics
NPI:1780729921
Name:SCOTT, WINSTON J (MD)
Entity type:Individual
Prefix:
First Name:WINSTON
Middle Name:J
Last Name:SCOTT
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 1:310 CENTRAL AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2835
Mailing Address - Country:US
Mailing Address - Phone:973-674-1070
Mailing Address - Fax:973-674-0219
Practice Address - Street 1:310 CENTRAL AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2835
Practice Address - Country:US
Practice Address - Phone:973-674-1070
Practice Address - Fax:973-674-0219
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38486174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0722405Medicaid
NJ0722405Medicaid
NJ085589Medicare ID - Type Unspecified