Provider Demographics
NPI:1194326504
Name:FOODY, SCOTT KEVIN
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:KEVIN
Last Name:FOODY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 ESPLANADE AVE
Mailing Address - Street 2:
Mailing Address - City:PITMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08071-2124
Mailing Address - Country:US
Mailing Address - Phone:856-812-3586
Mailing Address - Fax:
Practice Address - Street 1:162 ESPLANADE AVE
Practice Address - Street 2:
Practice Address - City:PITMAN
Practice Address - State:NJ
Practice Address - Zip Code:08071-2124
Practice Address - Country:US
Practice Address - Phone:856-812-3586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00185200225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant