Healthcare Provider Details

I. General information

NPI: 1699854638
Provider Name (Legal Business Name): SCOTT SVITEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 COMMACK RD
COMMACK NY
11725-3457
US

IV. Provider business mailing address

154 COMMACK RD
COMMACK NY
11725-3457
US

V. Phone/Fax

Practice location:
  • Phone: 631-499-8282
  • Fax: 631-462-5462
Mailing address:
  • Phone: 631-499-8282
  • Fax: 631-462-5462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number192623
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier01697158
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 2
Identifier457X11
Identifier TypeOTHER
Identifier State
Identifier IssuerEMPIRE BCBS
# 3
IdentifierAP662
Identifier TypeOTHER
Identifier State
Identifier IssuerOXFORD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: