Provider Demographics
NPI:1841547379
Name:NEPHROLOGY AND INTERNAL MEDICINE SPECIALIST, P.C.
Entity type:Organization
Organization Name:NEPHROLOGY AND INTERNAL MEDICINE SPECIALIST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:718-276-4750
Mailing Address - Street 1:1 CROSS ISLAND PLZ
Mailing Address - Street 2:SUITE LL4
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-1465
Mailing Address - Country:US
Mailing Address - Phone:718-276-4750
Mailing Address - Fax:
Practice Address - Street 1:1 CROSS ISLAND PLZ
Practice Address - Street 2:SUITE LL4
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-1465
Practice Address - Country:US
Practice Address - Phone:718-276-4750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty