Healthcare Provider Details

I. General information

NPI: 1649135930
Provider Name (Legal Business Name): SCOLI3D, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 BORDENTOWN AVE
SOUTH AMBOY NJ
08879-1546
US

IV. Provider business mailing address

141 SILOAM RD
FREEHOLD NJ
07728-8608
US

V. Phone/Fax

Practice location:
  • Phone: 609-726-5433
  • Fax:
Mailing address:
  • Phone: 609-726-5433
  • Fax: 844-471-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name: GLENN EASTON
Title or Position: OWNER
Credential: LCPO, BOCO, BOCP
Phone: 646-262-1845