Provider Demographics
NPI:1285491019
Name:SCOTTO PODIATRY LLC
Entity type:Organization
Organization Name:SCOTTO PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-444-2023
Mailing Address - Street 1:106 APPLE ST STE 200A
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2670
Mailing Address - Country:US
Mailing Address - Phone:732-444-2023
Mailing Address - Fax:949-955-5751
Practice Address - Street 1:106 APPLE ST STE 200A
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-2670
Practice Address - Country:US
Practice Address - Phone:732-444-2023
Practice Address - Fax:949-955-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ00991040Medicaid