Healthcare Provider Details

I. General information

NPI: 1578562211
Provider Name (Legal Business Name): MARTIN J SCOTT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 WHITEHORSE MERCERVILLE RD SUITE 102
MERCERVILLE NJ
08619-1953
US

IV. Provider business mailing address

2312 WHITEHORSE MERCERVILLE RD SUITE 102
MERCERVILLE NJ
08619-1953
US

V. Phone/Fax

Practice location:
  • Phone: 609-890-6363
  • Fax: 609-588-5225
Mailing address:
  • Phone: 609-890-6363
  • Fax: 609-588-5225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB04074700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number25MB04074700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: