Healthcare Provider Details

I. General information

NPI: 1871415885
Provider Name (Legal Business Name): DESMOND ROSS SCOTT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 LAKEVILLE RD
NEW HYDE PARK NY
11042-1118
US

IV. Provider business mailing address

527 LAKE CT
MIDDLE ISLAND NY
11953-2086
US

V. Phone/Fax

Practice location:
  • Phone: 516-734-8900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number312904
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: