Healthcare Provider Details

I. General information

NPI: 1831672302
Provider Name (Legal Business Name): SCOTT DAVID AMZLER NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 TECHNOLOGY DR
EAST SETAUKET NY
11733-3327
US

IV. Provider business mailing address

247 HIDDEN ACRES PATH
WADING RIVER NY
11792-2210
US

V. Phone/Fax

Practice location:
  • Phone: 631-675-9393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number308828
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: