Healthcare Provider Details

I. General information

NPI: 1245965078
Provider Name (Legal Business Name): ANDREA SCOTTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2022
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

111 E 210TH ST
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-3388
  • Fax: 718-904-3133
Mailing address:
  • Phone: 718-904-3388
  • Fax: 718-904-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number328980
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: