Provider Demographics
NPI:1992786826
Name:SCARPA, NATHALIE (DMD)
Entity type:Individual
Prefix:DR
First Name:NATHALIE
Middle Name:
Last Name:SCARPA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-1723
Mailing Address - Country:US
Mailing Address - Phone:973-754-4250
Mailing Address - Fax:973-754-4259
Practice Address - Street 1:21 MARKET ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-1723
Practice Address - Country:US
Practice Address - Phone:973-754-4250
Practice Address - Fax:973-754-4259
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI017814001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5471702Medicaid
NJ14836Medicaid
NJD0000076000Medicaid