Healthcare Provider Details

I. General information

NPI: 1699755710
Provider Name (Legal Business Name): GEORGE J SCOTT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1474 TANYARD ROAD SUITE D100
HAMMONTON NJ
08037-1135
US

IV. Provider business mailing address

1474 TANYARD ROAD SUITE D100
HAMMONTON NJ
08080-1135
US

V. Phone/Fax

Practice location:
  • Phone: 609-704-0185
  • Fax: 609-704-0195
Mailing address:
  • Phone: 856-566-6265
  • Fax: 609-704-0195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB06817600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: