Healthcare Provider Details

I. General information

NPI: 1598750937
Provider Name (Legal Business Name): SCOTT A. AMOSS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LACEY RD SUITE # 9B
WHITING NJ
08759-1325
US

IV. Provider business mailing address

400 LACEY RD SUITE # 9B
WHITING NJ
08759-1325
US

V. Phone/Fax

Practice location:
  • Phone: 732-350-0100
  • Fax: 732-350-0147
Mailing address:
  • Phone: 732-350-0100
  • Fax: 732-350-0147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number25MD00267600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number25MD00267600
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00267600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: