Healthcare Provider Details

I. General information

NPI: 1700864428
Provider Name (Legal Business Name): EVERGREEN PEDIATRICS SOLUTIONS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BAY AVE EVERGREEN PEDIATRIC SOLUTIONS, PC
MONTCLAIR NJ
07042-4837
US

IV. Provider business mailing address

3114 CROASDAILE DR STE 200 EVERGREEN PEDIATRIC SOLUTIONS, PC
DURHAM NC
27705-2508
US

V. Phone/Fax

Practice location:
  • Phone: 973-237-5795
  • Fax: 919-425-0478
Mailing address:
  • Phone: 919-425-1565
  • Fax: 919-425-0478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN R SCOTT
Title or Position: PRESIDENT
Credential: MD
Phone: 919-425-1565