Healthcare Provider Details

I. General information

NPI: 1093962615
Provider Name (Legal Business Name): SCOTT M PREGONT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 FISH AND GAME RD
HUDSON NY
12534-3815
US

IV. Provider business mailing address

PO BOX 2000
HUDSON NY
12534-2000
US

V. Phone/Fax

Practice location:
  • Phone: 518-828-7644
  • Fax:
Mailing address:
  • Phone: 518-828-8363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number246069
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: