Provider Demographics
NPI:1316932841
Name:PASQUALE J SCOTTI MD PC
Entity type:Organization
Organization Name:PASQUALE J SCOTTI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PASQUALE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SCOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-963-2383
Mailing Address - Street 1:589 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-3605
Mailing Address - Country:US
Mailing Address - Phone:718-963-2383
Mailing Address - Fax:718-963-3780
Practice Address - Street 1:589 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-3605
Practice Address - Country:US
Practice Address - Phone:718-963-2383
Practice Address - Fax:718-963-3780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101507207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00174621Medicaid
NY00174621Medicaid
NYW8CC81Medicare PIN