Provider Demographics
NPI:1699702217
Name:BEELES, SCOTT D (RPA)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:BEELES
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HORWOOD PL
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-4510
Mailing Address - Country:US
Mailing Address - Phone:315-394-9462
Mailing Address - Fax:315-713-5291
Practice Address - Street 1:100 HORWOOD PL
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-4510
Practice Address - Country:US
Practice Address - Phone:315-394-9462
Practice Address - Fax:315-713-5291
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003957-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01828688Medicaid
NYP25391Medicare UPIN
NY01828688Medicaid
NYPA1132Medicare PIN