Healthcare Provider Details

I. General information

NPI: 1750714309
Provider Name (Legal Business Name): FRANK SCAFURI III, DO, P.C. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 MAIN ST
KEANSBURG NJ
07734-1734
US

IV. Provider business mailing address

199 MAIN ST
KEANSBURG NJ
07734-1734
US

V. Phone/Fax

Practice location:
  • Phone: 718-370-3730
  • Fax: 718-698-9412
Mailing address:
  • Phone: 718-370-3730
  • Fax: 718-698-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number25MB09048000
License Number StateNY

VIII. Authorized Official

Name: DR. FRANK SCAFURI III
Title or Position: OWNER
Credential: D.O.
Phone: 718-370-3730