Provider Demographics
NPI:1982600656
Name:DAVID, SCOTT HENRY (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:HENRY
Last Name:DAVID
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 W AIRLINE HWY
Mailing Address - Street 2:STE A
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-2952
Mailing Address - Country:US
Mailing Address - Phone:732-929-9426
Mailing Address - Fax:732-240-0261
Practice Address - Street 1:42078 VETERANS AVE STE G
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1490
Practice Address - Country:US
Practice Address - Phone:985-542-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB63962207P00000X
LA309021208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7044208Medicaid
NJ7044208Medicaid
NJG00668Medicare UPIN
NJ891342Medicare PIN