MEDICARE: MICHAEL SCRIMENTI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	25MA03974600	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00415504	OTHER	NJ	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164516704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL SCRIMENTI M.D.

Provider Business Mailing Address
First Line	:	400 FRANKLIN TPKE
Second Line	:
City	:	MAHWAH
State	:	NJ
Zip	:	07430-3516
Country	:	US
Telephone Number	:	201-818-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 FRANKLIN TPKE
Second Line	:
City	:	MAHWAH
State	:	NJ
Zip	:	07430-3516
Country	:	US
Telephone Number	:	201-818-9100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	11/19/2007

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