Provider Demographics
NPI:1831242668
Name:ROBERT E. SCULLY, MD,PC
Entity type:Organization
Organization Name:ROBERT E. SCULLY, MD,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCULLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-423-5400
Mailing Address - Street 1:365 W JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6362
Mailing Address - Country:US
Mailing Address - Phone:631-423-5400
Mailing Address - Fax:631-423-5423
Practice Address - Street 1:365 W JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6362
Practice Address - Country:US
Practice Address - Phone:631-423-5400
Practice Address - Fax:631-423-5423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164326207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW31111Medicare ID - Type Unspecified