Healthcare Provider Details

I. General information

NPI: 1568579050
Provider Name (Legal Business Name): SCOTT LAURENCE HAUSEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 HUGUENOT ST
NEW ROCHELLE NY
10801-7760
US

IV. Provider business mailing address

2700 WESTCHESTER AVE
PURCHASE NY
10577-2547
US

V. Phone/Fax

Practice location:
  • Phone: 914-848-8060
  • Fax: 914-607-5856
Mailing address:
  • Phone: 914-607-5730
  • Fax: 914-457-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN0049501
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN004950
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: