Healthcare Provider Details

I. General information

NPI: 1033186937
Provider Name (Legal Business Name): SCOTT B POMERANTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 FOREST AVE
PARAMUS NJ
07652-4737
US

IV. Provider business mailing address

523 FOREST AVE
PARAMUS NJ
07652-4737
US

V. Phone/Fax

Practice location:
  • Phone: 201-262-5070
  • Fax: 201-262-5333
Mailing address:
  • Phone: 201-262-5070
  • Fax: 201-262-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMA54400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: