Provider Demographics
NPI:1194768580
Name:SCOLNICK, ITA (MD)
Entity type:Individual
Prefix:DR
First Name:ITA
Middle Name:
Last Name:SCOLNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:447 ROUTE 10 EAST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869
Mailing Address - Country:US
Mailing Address - Phone:973-361-2860
Mailing Address - Fax:973-361-3419
Practice Address - Street 1:447 ROUTE 10 EAST
Practice Address - Street 2:SUITE 16
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869
Practice Address - Country:US
Practice Address - Phone:973-361-2860
Practice Address - Fax:973-361-3419
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA043655208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics