Provider Demographics
NPI:1104963503
Name:SCOTTI, ANIELLO (DPM)
Entity type:Individual
Prefix:
First Name:ANIELLO
Middle Name:
Last Name:SCOTTI
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 1:484 WILLIAM FLOYD PKWY
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-3415
Mailing Address - Country:US
Mailing Address - Phone:631-281-3100
Mailing Address - Fax:631-281-3108
Practice Address - Street 1:484 WILLIAM FLOYD PKWY
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-3415
Practice Address - Country:US
Practice Address - Phone:631-281-3100
Practice Address - Fax:631-281-3108
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0049101213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01632860Medicaid
NY480027284OtherRAILROAD MEDICARE
NY4579830001Medicare NSC
NY480027284OtherRAILROAD MEDICARE
NYU43252Medicare UPIN