Provider Demographics
NPI:1194707570
Name:SCANDIFFIO, CATHERINE CARMELA (OD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:CARMELA
Last Name:SCANDIFFIO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 PERIMETER ST
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-3822
Mailing Address - Country:US
Mailing Address - Phone:631-648-0934
Mailing Address - Fax:631-434-1728
Practice Address - Street 1:601 SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4309
Practice Address - Country:US
Practice Address - Phone:631-231-4455
Practice Address - Fax:631-434-1728
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT006245-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2423274Medicaid
NYU92402Medicare UPIN
NYC222E1Medicare ID - Type Unspecified