Provider Demographics
NPI:1932166295
Name:PICKETT, SCOTT J (DPM)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:J
Last Name:PICKETT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MCCLELLAN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1019
Mailing Address - Country:US
Mailing Address - Phone:518-573-9180
Mailing Address - Fax:
Practice Address - Street 1:700 MCCLELLAN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1019
Practice Address - Country:US
Practice Address - Phone:518-573-9180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005216213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
51412OtherGHI HMO
480031024OtherRAILROAD MEDICARE
231421OtherWELLCARE
PB7982OtherBCBS
360745OtherMVP
000497248001OtherBLUE SHIELD
10046654OtherCDPHP
6299002OtherGHI PPO
NY01668244Medicaid
10046654OtherCDPHP
480031024OtherRAILROAD MEDICARE