Healthcare Provider Details

I. General information

NPI: 1346462686
Provider Name (Legal Business Name): MR. ERIC GREGORY SCOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215-217 WEST 135 ST.
NEW YORK NY
10030
US

IV. Provider business mailing address

86 W 119TH ST APT 2C
NEW YORK NY
10026-1427
US

V. Phone/Fax

Practice location:
  • Phone: 212-694-3500
  • Fax: 212-694-4998
Mailing address:
  • Phone: 646-296-8906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: